Homestead_McCormick (2) CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
rj��.,K STANDARD/SUPPLEMENTAL DEDUCTION
r ' Sea Form 5473(R17l 1-16) HC70
Proscribed try the Dgmtnea of local Govmyoa Far
INSTRUCTIONS:See reverse side for hang bsM,rbons
NOTE Telephone,Social Seaatlx drivers license,slate Add n65Ugon end federal identlIcaEon numbers are a,nffcprIDal muter IC 6-1.1-12-37. @�J'`1•
)(ade) , N that I(we)Homestead ro ffi
place of residence cram(are)buying the following desadyetl real property under contract for which I He)occupied
P T b
Deduction is hereby daimed on the date this application's signed, (date of sign I
❑ Am(are)firing under recorded contract.
1:1 S E P 18 2017
Am(are)entitled to oc ipy 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 personal residence Nut
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. • I ai
• -
Cant' Toesshp Tea district(city,towel beerbb)
•
•
Paid nmmer legs aaai.tas Its rte pma) canton
py in canto
❑Real Rcpay ❑A.vtaey assessed motile tare(IC 6-1.1-i1
If any proton of ere reSidnal morass or the lam not eacaed g ere(1)an eat th eaaey arrant that sun,'is Used b produce Income,describe the use ant portion
crI the property tatted to produce item.
aCo - 12 -18-302 - 000. 6.14-cag
=,$, v-M _ l'-'"- j�PROPERTY OWNED ELSEWHERE BY CLAIGIANT '.�z .t.'`o- _,i
Ste,Cary,an Tomdtp Is claimant vacating a homestead?
0 Yes 0 No
sgatae of donned
1 hereby catty the above sFateiielts are true,correct and complete. /4 n& t/YI ��
Address d acid(mete-an street My,stale,end Z,PmW) d Nyaoed Asmte.d,leery Onberanraeet sty,she,aN ZIP epee)
",ASSESSOR USE OILY 'i ASSESSEDVALUE�y °.z'uo, ESTE O JALUE."-I -'Th tr' VALUE
NTIALr�---
Land not exceeding one(1)acre Immediately 14 °rl"�1
surround-mg resMential improvements (1)
K %t
Doer lane (2)
Total land(line 1 plus tine 2) (3)
Residential Improvements m Dwelling (4) t -ate-_-.- -
annually assessed motile - '
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 0 through Tine 6) (7)
Total value pone 3 pia line 7) (8)
I hereby certify the above is true,correct, SW-mta otAssessor pale soar'(natty r2y,year)
and complete.
Verifying moon-SNraaze/rAusb Date mgaL(natty day:yea)
. -a- 't '-<:..'Z- STANDARD DEDUCTION ALLOWANCE - -
20_Pay 20 Lesser of 60%of the assessed vdue of the homestead or$45.000.
NolriUUtamdrp any other prevision,the sum of the deductions provided in IC 6-11-12 b a mobile home S •
that/s not assessed as real property or to a manufactured home Mat/s not assessed as teal property may
not erceed at(1/2)of the assessed vs mime nrhea hone or roared-attired home. rs Fix') //�
Ware 01 Dalt(O61WBUTION:Original-CartyAuctico FisSmm ped Copy-in/payer
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