Homestead_Moore CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD!SUPPLEMENTAL DEDUCTION
s�leForm son(Rnn-16) HC10 2019
'• Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Secunly,diner's license,sate idenfification and federal identtcation numbers are confidential under IC 5-1.1-12-37.
I(We) Mathew S-Macre certify that I(we)occupied as ( . I
place of residence or am(are)buying the following described real property under contract for which a Homest o Ta to
Deduction is hereby claimed on the date this application is signed, 05r7115 (da I 'gn u I :
I] Own. ❑ Am(are)buying under recorded contract. 1-1 /\9
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ````((�� 1
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified persona auence trust.
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
PVO pF
Name of claimant(legal name) Telephone number of cI n '(
Matthew S. Moore ( ) p �
Social Seanty number of claimant's spouse(last five dgts) Drivers license/laen44catpn/Otter number of daonam i spouse(last five dgts) Issung Sate
(Appbcable Only if appbcantl spouse does not have a social sectary number.)
- - - . CONTRACT RECORDED, ,
If buying on canna,Fee Simple owners lame
Reorders office Mere contract is recorded Record number I Page
_ r. PROPERTY DESCRIPTION -.
county Township Taxing district(city, township)
Giwn ty,row
bson Montgomery Montgomery
Parcel numMr Legal desurpton Is the progeny in wesbon:
2617-04_00-005.420-021 0 Real papery 0 Annually assessed noble home(IC 61.1-7)
II any portion of the resSen]al structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the pogeny utilized to produce income.
26-17-04-400-005.420-021
- PROPERTY OWNED ELSEWHERE BY CLAIMANT . - '
State.Counly,and Township Is claimant vacating a homestead?
0 Yes ID No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. i //
Address of contact(number and meet sly sate and ZIP ode) Address of vacated homestead,rany(numbeeraand meet ray state.and ZDPode)
5185 S 960 W, Owensville, IN 47665
ASSESSOR USE ONLY,. I ASSESSED VALUE -._I HOMESTEAD VALUE 1 NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1) -
surrounding residential improvements -
Otherland (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 I through line 6) (7)
Total value (line 3 plus line 7) (6)
I hereby certify the above is true.correct Signature of Assert« Date'synod Qnoltt.day may
and complete.
Venty'ug action-Signature of Auditor Date signed(miler,day,year)
4 08/14/19
. STANDARD DEDUCTION ALLOWANCE n , - - -
20 pay 20 Lesser of 60%of the assessed vaue of the homestead or 545,000.
Nohwthstandirg any other provision,the sum of the deductions provided in IC 6-1.i-I2 to a mobile horse S
that is not assessed as real property or toe manufactured home that is not assessed as zeal properly may
not exceed one-half(1/2)of the assessed value of the mobile home or many lectured home.
Signature of tud:tor Date signed(moron.day bean
‘91111-i-t-5114-C r;y- 08/14/19
131STR1auT10N:Orginal-County NMitor,FileSUnsed Copy-Taxpayer
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