Homestead_McConnell ti-- CLAIM FOR HOMESTEAD PROPERTY TAX -- - YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM 1
Stab Fam 5173(R17/1-16) HC10 / '
Resorbed A'Ow Depmtrnal a(Leal Goverment •[�'(��I
INSTRUCTIONS:See reverse side for fling instructors
NO7E Telephone,Social Securtlg
rises's femme,slate iderrt5ofoe and federal lair th no:nbns are oonfidenial under IC 6-1.1-12-37.
I OW (�'n 1 c e • . certify that I(we)occupied as my(on)principal
place of residence or am(are)buying tie following described real property under contract for which a Homestead Property Tax Standard
�����De//duudbn is hereby claimed a this
the date application is signed. (date of signature). 1(We):
Own. 0 Am(are)buying under recorded contract
❑ (are) entitled to DDarpy 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 personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the properly.
Name of claimant(legal�°�—�
!... daima'a spouse(tar fne rests) Issuing Sate —
i I ' i1
• :CONTRACT RECORDED - -. ( - .. - . '
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Pa�rr,N o O . ale 1 bo,yqp�sly i,arem¢ Cif Ano1n c
/1Q�\R eat property 0 A-emay assessed (IC 6-1.1-7)
If ary paean d the residential curare a the lad not essed.-g or(1)we ea inrmagy ams�s the snare a used b practise Home•desmbe the use aid potion
d the pm any mind b pvdm acme.
_ .--% _. -:PROPERTY OVWNED ELSE WHERE BY CCAIM3 It ;.:<..-
State.Casey.adTondo ..Is `2r9Enp a homestead?
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a dabea - f e 1 t-WR-AA,Q
I hereby certify the above statements are true,tyxrect,and complete.X �e A r
Address d arlaa(ramtaerend street all:sate.and ZIP code) a sauced)orneate d ne,it. (amber a Shea.oty.as.at ZIP ad)
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-. ' - `ASSESSOR IISE ONLY •_i - ASSESSED VALUE.a�'.1 ,. TE O VALUE.-- N0D-RV LUE -NTIAL
Land not exceeding one(1)acre Immediately - ... •_ o�i- z 3.� x _--;{
surrounding residential improvements (1) c 'vc 1 -.-+ir,
Other land (2) . -a. .e ._- ,.
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4) t "" ,,?- '•�,'��,i
annually assessed mobile/ -s q .:.:43
s..
manufactured home Garage (5) - -..kY_'- . n.. -'.._.,ir.
Other improvements (6) . x V{L $'7Z-'C
Total improvements(line 4 through line 6) (7)
Total value (line?pros Una (a)
I hereby certify the above is hue,correct 6ptatn of Assessor Date signed(made tax yea)
and complete.
vefyrg action-Signature onwitor Date sired(myth pay,e a)
- - _ -SST?NDARDOEDUCTIONALLOWANCE t_- - y
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwehsianrdng any otherpmvision,the sun of the deductions provided in IC 6-1.1-12 to a root*home $that is not assessed as real property or to a manniacbled hone that is not assessed as real property may
not exceed one-ha(11Z of the assessed vaka o✓the nnbie home or home.
6iTataealwdbr c. ��1 `j'l.� C �2 15 .
DISTREILMCW:Original-Canty Auden,ReSanped Copy-Tmpaya
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