Homestead_McIntyre (3) ..pper� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
-e ? STANDARD/SUPPLEMENTAL DEDUCTION FORM
r• Slate Form 5473(RIS 1 5-14) HC10 I
•• Presented by the Department of Local Govemment Finance .— y.�
INSTRUCTIONS:See reverse side for filing instructions. - .1Qipry`ywgyL\
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers am confidential under IC 6-1.1-12-37,
" - CERTIFICATON STATEMENT' - . ' - • .v )3/4113(1 a-7...-Y'
I(We) nArki//._ /i r /.ri . •-rtify that I(we)occupied as my(our)p n..1.15
place of residen/or am(are)• ing Ne following described real property under:•ntract for which a Homestead Pr.�.r' Tax Standard
Deduction is he -by claimed on the date this application is signed, (daterof sig �7 IY e:� o
uu I
Own. ❑ Am(are)buying under recorded contract. �QN CQ ��.
Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. UN r
Allegros?
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
If buying on contact Fee Simple comers name
Recorders oftce where crony is recorded Record number 1 Page
cP xarc !
Township 1 Taxing e - ( wnshp)
ter Legal (Lion // //y� Is the pr ry'n Ces6m:
JJJJ -c4J i] C' I L7[Real property ❑Annually assessed mobile home(IC 6-1.1-7)
If arcraolien of the resider al toucan or the nC not exceedvg one(1))Laae - ray a/Vaat=can s used to produce income,describe cie use and pcet n
of r_h_Vperty iterated to produce tcoce. Q (^///app(((
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,Canty,and Township Is claimant varadng a homestead?
❑ Yes fl No
ure of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(Wunder and Weer oay,state,and ZIP code) dress of S rated horestead,d any(number r 'street.may sate.and ZIP code)
X \)-16(0 C% r\ -c \10 �o-1 k71�6t�k, V1G3
Land not exceeding one(1)acre immediately .I(1)
surrounding residential Improvements
Other land (2)
Total land(line 1 plus line 2) (3) N.
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other Improvements (6)
Total improvements(line 4 through line 6) Q)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct. Signature of ASSessw Dare signed(month.day year)
and complete.
Verifying action-Signature of P E.:ar Date signed(month,day,year)
--P ''76'7.1:::-•>5•J - 0•••"cc STANDARD.DEDUCTION ALLOWANCE i :. . -=":Vi=a
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
AbMtthstanding any other provision,the sum of the deductions provided in IC 6-I.1-12 to a mobile home S
that is not assessed as real property or toe manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
Signadae of Auditor Date signed(month,day,year)
DISTRIBUTION:Original-Cowry AUdrar,FdeSamped Copy-Taxpayer