HomeMy WebLinkAboutHomestead_McConnell (2) CLAIM FOR HOMESTEAD PROPERTY TAX 1 YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Farm 5473(R151 5-14) HC10
' Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,drivers license,stale identification and federal identification numbers are confidential under IC 6-1.1-12-3 _ .la
. - - CERTIFICATION STATEMENT I Ir 1.'1 . �r I r«q 5,
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(We) /_r i��Y�1Z��' certify that l(w.:occu..-. ri-'• •
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of lure:061(n5
❑ Own. ❑ Am(are)buying under recorded contract. JJ(U� 1111 LU
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the must or the right to occupy the property under the terms of a qualified nail. • ust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
* . : 11 TfR
_ - - -
'
It buying on contract Fee Simple owner's name
Recorder's o5ce where contract is recorded Record number I Page
w.'. __ y - ',- . ..:::: : *:PROPERTY:DESCRIPTION?- -.-.iii ts±4_ _it -., ,:-V=-.--s-is
Carry Townsip Tytitg dSTq(o4t loon,tom-she:)
Parcel arber L desaiPVOn /- ,4 1 Is the question: .
Ls // 9)eal property ❑Mnuaty assessed mobae tome(IC 6-1.7-7)
It arty pot of the rezkertal=case or the land not exceeding one(1)acre that immediately surmags that stuoute is used to produce income,describe the use and porton
of the property tamed to produce income.
410—// -/7 -(loo 00 ti. 5 9K oa /
PROPERTY OWNED ELSEWHERE BY CLAIMANT
1 Sate,County,and township Is claimant vacating a homestead?
Cl Yes WO
sigrab e of clamant 7"
I hereby certify the above statements are true,correct,and complete. � `ti) a� _a 2
x'n (number and ,gate,and ZIP code � � ,� �,vacated
17T .d any(number eMnore/f41{rNl�gate,and ZIP code)
Landdnnott exceeding one one(1)acre immediately A// (1) I V (/
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3) I
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,reel.)
and complete.
:'yvg anion-Signature of Ard:ta Data Signed(north,day,year)
20 _pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a 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.
signature of Date signed(matm,day,Year)
� 7 _ �-,,,,--7-1 -7- to-/y
DISTRIBUTION: Onginat-County Aud or.Fie-Stamped Copy-Taxpayer