Homestead_McIntosh CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
A_ STANDARD I SUPPLEMENTAL DEDUCTION FORM / /
HC10 'd //'17 V
Sate Form 5473(R15/5-14) !!!
i• Prescribed by the Depamnent of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
- - ' ._ - - , CERTIFICATION STATEMENT' ' i __v- -`BV_ -,2- : –'—.
CC � �����i�t��
• ' ,FT- I! (We)ocP,CT 1 �R11 yA FF. '';jl.N
place of residence or am(are)buying the following described real property under contract for which a Hors .-..: ,, .P=;• 6 '. ransfer -
Deduction is hereby claimed on the date this application is signed, (date W signurek I(We): I
,��q�'yw"�'r'h' ❑ Am(are)buying under recorded contract. 9 JAN 4 20 "
IJ Amw(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have❑ Am (aare)ethe in the
partner, or member of to occupy tity that owns property.terms of a qua r ;;fir•-�ja,°{�� " .7 milt on County
- :=_
Recorders pace where contract is reraded I Record number Page
I
Coutcy I Towyrhip Taxing did• (at lea toxnship)CST
AL Parcel number legal desorption Is the property�es
Real property ❑ Annual?),assessed mobile home(/C 6-1.1-7)
If any carbon of the residential sincere or the land not exceeding one(1)acre that immediately surrounds that structure 5 used to produce income,desmbe the use and pat=
of the property vd¢ed to produce income.
07 Io-/c -deo- .oy -Ocy. a ?/ - 0.2 & -
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Sate,County.and Townstup Is claimant vacating a homestead? I
❑ Yes ❑ No
�Signis'{re of ant__
I hereby certify the above statements are true,correct,and complete. '/
Address of monad(numberare greet mty,state.end ZIP=del 4y14iJ I Address of vin . hecneatead.d any mumLer and street rm.gale,and ZIP code)
•_2
ASSESSOR ONLY �j r `CIAO L NONRESIDENTIAL
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I VALUE
Land not exceeding one(1)acre immediately I(1) I
surrounding residential Improvements
Other land (2)
Total land(line 1 plus line 2) (3) -
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,correc4
Signature of Assesses Data signed(month,day,year)
and complete.
`.'sing action-Signature of Auditor Date signed(mond;day.year)
.--C.'� :?>7 r– Fr-;177,7,376-_-STANDARDDEDUCTION ALLOWANCE."r -: '--,--wt
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
No.Mithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home $
that is not assessed as real properly or to a manufactured home that is not assessed as real properly may
not exceed one-half(I2)of the assessed value of the mobile home or manufactured home.
Sgraahre Lja ill Date signed(ninth,day,Year)
DISTRIBUTION: Original-County Atditor,Fie-Damned Copy-Taxpayer