Homestead_McClellan �-'�re-- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
E e. STANDARD/SUPPLEMENTAL DEDUCTION FORM
�' State Form 5473(R1711-16) HOW
Resulted by me Department(Local Gooemrert Romeo
RJSTRUCTIONS:See mere side for Sag itsbucifons
NOTE Telephone,Social Security liter's @cense,state identrfica5on and federal in nwnbea are mnfde+Nal under IC 6-1.1-1247.
1(We) 1�r1g M �' lP_ I1an De wr Thal yg(
place of residence or am(are)buying the toFowing described real property under contract for which a Homestead P ry�c
Deduction is hereby claimed on the date this application is signed. (date of wig ). • I D
IA Dan ❑ Am(are)buying udder recorded contract
❑ Am(are)entitled to oaafpy as a tenant-stockholder of a cooperative housing corporation- JUN 2 7 2018
❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified personal residence trust
❑ Arm(are)the shareholder, partner,or member of the entity that owns the property. �I �
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Gamy- Township 'rasing ddsld(ant,fora,lame-.?)
MontcS)orner•
Pawl neuter legs desap`m Is the p(*my it question
NN SE ti-3-la Luca ®Real RoPertY ❑Annually m.mCnotia ham(ID 6-7.1.7)
gay portal of le reddaY¢I thrt re or me laid nil eateedrig one(II acre e®tnmedalay sstoaids that sanctum is used to pumas thane,death.tM me aid purist
of es properly[bleed b prom thane.
2.10- 1-1-04-'- oo-oc1 .385-o21
:-?! .. PROPERTY,OVINED EELSE 'HERE6Y,CCHIhiANT -, L1--- :...- -r4A--"evt :.
Ste,Cattt and Township Is claimant vacating a homestead?
❑ Yes ❑ No
I hereby certify the above statements are true,correct and complete. L_ L,r��,/�f 7te
Ames d confect(rammaad steel thy.a Me,and Z/Pmt) G1 AAd&eea"d/ �ldtw.s>e.d lamw/therwawe(al:a..and ZIP wa)
0 W 1 5 DW'ha u i I I Q n S
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4
slaTo ncrom residential Immediately (1) ,,,_;,.Ky,.v-7--4>3!+._M<*t. :is
Land notex eeding one(improvements)) mme ia
Other land (2) __r i -_.- .. .._'
Total land(line 1 plus line 2) (3)
- 13 vw. ,...
Residential assessed mobile or Ovremtp (4) =:P _ "iu-:=/-d,A ;=e_'r
annually assessed mobile/ ''x
.
samaarretl hoop tangs (3) :..q_ v rM.i?C.;=.- `s
c w 'Other Improvements (6) 53; s4
Toth
Improvements(loss 4 though rue 6) (7)
Total value (line 3 plus rune 7) (B)
I hereby certify the above is true,correct, She of Assessor Data signed(rnoraq der:Ma)
and complete.
Va'dyne action-Siaatre SNdbr Dam signed(nmfl dal Yea)
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20 pay 20 Lesser of 6096 of the assessed value of the homestead or$45,000.
NotMNsland g any oterpovisbr,the sum of the deductions provided in fC 6-t 1-12 toe mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real properly may
not exceed one-hal(1/2)of the assessed value of the rmbde home or manufactured home.
Slims cfthaw %lam✓i..l d\C Date silted broth.that Yee)
CeSIWBUTION:Original-COaryAta4a,lie-Sapped Copy-Taxpayer
Page 1 of 2
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6
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
l%/$Tii�/�:Tln/1�Sf iAP lPVP.l.SP SIf�P f0l /1/100IOSilllf.f1011S
�'t ' y . . .. � y YEAR
t;����M.(p'��
'�- HC�O•:i>s.-�
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- CERTIFICATtON STATEMENT •�.�_i--. ,.le,���
� �(� �Q '�:ro� f
I(We)�, S\ �� Q, �! D �L w� � certify that on the 1 st day of March, 19_
I(4Ve) occupied as our principal place of residenc�ollovring described real property for which a Homestead Property Tax Credit is hereby claimed:
�(VJe) owned ❑ Are buying under coniract
❑ ave a beneficiai interest in the entiry that is liable for the property taues on the property and that owns the property or is buying under a contract.
CONTRACTRECORDED
If buying on conUac[, Fee Simple ownefs name
Fecortlers oHice where contract is recorded - Record number . � Page
PROPERTY DESCRIPTION
Counry Township Taxin tlistrict (city, r wn, mwnship)
Parcel number Legal tlescnption
a o -a
I( any portion of the resitlential structure or the IarM not exceeOing one (1) acre Nai immetliarey surtounds ihat suucture is used to produce incwne, deuribe the uu and portion of
Ne property utilizetl to produce incrome.
�- o� °a- �►! 3�,� Da-/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry TownSNp Counry Township
SignaWre of claima t
., ereby certify the above statements are true, correct and complete. �t
Addreu (numbe�ands7reel, ciry, srate, ZlPCOde)
.62 R�� � c� Pn.r� �Lr .z L? ls la S
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 1(one) acre immediatety (�)
surrounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvements
Garege (5)
Other improvements (6)
Tolai improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signamre oi Assesor Dare signed
complete.
Verifying action - SignaWre of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
79_ Pay 19 _
Lesser of 1/2 Homestead �
Valuation or $2,000
Sgnature of Autlitor Date signed
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