HomeMy WebLinkAboutHomestead_McEllhiney (16) tt•.�i CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR I
t:, STANDARD/SUPPLEMENTAL DEDUCTION FORM
���,p{aap Sate Form 5473(Rt5/5-14) HC10
"cap.:
Prescribed by the Department of Local Government France
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential under IC.1. 211, T -
iy:r a _ri 4'.. ..;:-T-n-II It,rCERTIFICATION 5TATEMENf .7F,.T'F,v^-. r-',%e ,,,Wee ,yy, ^/i '- '";
I(vre) , , Al AIL :assts., certify that I(we)occupi- s rnyr(ou' n
place of resl.ence or am(are)buying the following described real propelunder contract for which a Homestead Property Tax Standard
Deduction is hereby daimed on the date this application is signed, (dare of signatureh U U -1 015
6 q
❑ Own. ❑ Am(are)buying under recorded contract. 6 L J
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified persona e
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. /
GIBSON C• DITOR
If drying on contract.Fee Simple owner's name
Recorders office where con:nc is rebated Record number Pape
_.ms .s "-^ia-S- :`g_ d'gi aPROPERTYDESCRIPTON CIZSr> . -X 4Wi '+a ti
Can:/ Township Taxing Ns. : .town,township)
i "_r—w _1
.
Parcel number Legal desaiipptscn I Is the properly rt.ouestcn:
w _ , , ,dip Real property ❑ Annually assessed moat tome(IC ti1.1-i)
If any por of the residential=duo at the land not exceeding one((I)aafox that ir:.nediate-surrxmdsY s structure in:seer to produce income.oese pe the use and por on
of the property utilized to produce th ome.
PROPERTY OWNED ELSEWHERE BY CLAIMANT ,
Sate,Cony.and Towrstup Is claimant vacating a homestead?
❑ Yes ❑ NO
sigraure at claimant
I hereby certify the above statements are true,correct,and complete. Jc't
bit' ft�Q( 2 n
, of contact(number and Street oty.slate,and ZIP code) �I,� I Address of vacated nonecead,d any(number and dree5 oly.slate,-nd ZIP oboe)
'c I I 1 4 M r S-t L;;( S-f. pA,i.hditel,ThR0
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE ' I '' NONiiE�SIDEENlAL-- '..
Land not exceeding one(1)acre Immediately I(I) I . - t -
surrounding residential Improvements ..
Other land 1(2) I ... .-..
Total land(line I plus line 2) (3) I
Residential improvements or Dwelling (4) i
Annually Assessed Mobile I -Manufactured Home [Garage (5)
Other improvements I(6) - -
Total improvements(line 4 through line 6) I(7)
Total value (line 3 Os line 7) (6) I I
I hereby certify the above is true,correct.
of Assessor Date signed(month,dap year)
and complete.
Veotwg action-Signature of AuCcor Date signed(month,day,year)
.'.iii"a �'7.kry 'elt- ? =1 -a<atrF= =STANDARD:DEDUCTIONALCOWANCE 1t '��--1 t^•y
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Abtithsanding any other provision,the sum of the deductions provided in 1C 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.
S Au1iw Date sgnec(mat",day year)
DISTRIBUTION:Original-Caurcy 4uddw,fie-5amped Copy-Taxpayer /{�
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