Homestead_McDonald CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4.' ' STANDARD/SUPPLEMENTAL DEDUCTION FORM
t State Fenn 5473(R1 7/1-16) HCig 10t9 .
Arrsig Prescribed by The Department a Government Loud Government Arena 11
INSTRUCTIONS:See rewase side torbbng 6tWxtions.
NOTE Telephone,Soda/Seaaib tees lcense,state iddth:eaten end federal idertficabon numbers are mnkdvial under IC 6-1.1-12-37.
I(We) (.'- • R e certify that I(we)occupied as my(our)principal
place of residence (are)buying the ' described real property under contrail for which a Homestead Property Tax Standard
action is hereby claimed on the date this application is signed, (data of signature). I(We):
• Own. 0 Am(are)buying under recorded contract
rif Am(are) entitled to occupy as a tenant-stockholder of a
PY cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the piuperty under the terms of a qualified personal residence bust
❑ Am(are)the shareholder, partner.or member of the entity that owns the property.
- • CLAIMANT'S INFORMATION . • -
!tame aldaairg )
Sone Secutya
So®I Smutty number of dauoa %Rase elan The die#) Ores Scenes/I eali5caEan/Ow puma of theatres spouse last Se ashy lssag 3xa
(AJfa®ate only/op:mY's Rang class nn has/a soda!secaPymmber.)
- - CONTRACT RECORDED - - . ,
Staying on couaa.Fee 5unpb aumefs runs
Rends%on®where wt'da is reamed Read number Page
., - ,PROPERTYDESCRIPTION.•','� . _
Ca+rty q Torskp Taxingd(ty,town,roerslip)
_Paced ti 1pd 6valpm moen a ces Y tiou,
Real FeWeny 0 Analy neared moNelme(IC 6-1.1-7)
If any porton a st le resberrial atu ore as laid in eseedig me(1)at b e a iimmediatelimmediatelyauca.e is used to pro®ianne,sesame The use aid portico
a the property'd&ad to produce krone
2.6cl3 - 2o - 2O0-oo1 . 1814 ^o° L+
",r-' PROPERTYOWNEDELSEIYHERE BY CLAIMANT - - ... -, -
Sam,Catty.aid Towship Is dabsent a g homes
tead?
stead?
Ell Yes (})L No '
a..•, jt
I hereby certify the above statements are true,co and red,a complete. + Y q '
Address a mraet(co a nberd street ciy.alto,and BP code) i` ,•.-'- erdahxt oy,sxe,-. .,--..-)di. . 6 a., c.,w.3 0
,- ,ASSESSOR USEONLY ._`41 ASSESS DVALUE- a.,t HOMESTEAD\ALUE• ... NON RESIIUENTIAI 4-,.- 1 ,
Land not exceeding oneo (1)acre Immediately 'i1 T--� " -i' w1"1l `17�•I1
sunundmg residental[improvements
mprovents (I) _, ti-A°S c* Y
-
•
Other land (2) c _ Zp
Jy
Total eon(line 1 plus fine (3)
Residential Improvements or Dwelling (4) F IL E
. .y a Y.r s
.
annually assessed mobile I
manufactured borne Garage (5) p �t14(f -Y_Y.._ ._. .._.
Other improvements (6) tax, ., Q`p!r 1 O_;,4�11 J
Total improvements(fore 4 through line 6) m
Total value(fine 3 Phu One 7) (6)
where the above b true,correct *mare at Assesses' GIBSON�Y OR4d3nea4
Verifying action-%Orden/Naar Dam sinned(matt,deg ergs)
20_pay 20 Lesser of 00%of the assessed value of the homestead or$55,000.
NoMZhstandi g any other provision,the slap of the deductions provided in IC 6-1.1-12 to a mobile home $ •
that is not assessed es real property or to a manWadured home that is not s•seesad as real propehy may
not exceed one-hall(12)of the assessed yaks of the mottle home o home.
Signature aNrdtor Sh S i 1' 8 19 -
cISm stmoN:Original-Carty Au6ta,,FiaSTanped Cad-Temayer
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