Homestead_McDaniel , -.,%4a. CLAIM FOR HOMESTEAD PROPERTY TAX
i }. STANDARD/SUPPLEMENTAL DEDUCTION FORM
s� _ 5)1 State Form 5473(R18/1-20) HCIO _
j,� Prescribed by the Department 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/C 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) 1 4 44-N r-f•C 16 _n 1 - I certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real propedy1/and contract for which a Homestead Property Tax Standard
Deduction� is hereby claimed on the date this application is signed. 1 -6-Z.Z (dale of signature). I(We):
[]i'Own. ❑ Am(are)buying under recorded contract.
❑ Am (are)entitled to occupy 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 trust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number 'a:
PROPERTY DESCRIPTION
. 471)
County Township Taxing district(city town,township)
(� 1 7CCIr,I r�ci— 1 AP
Parcel number Legal descnptio (Is the property in question. 8
, ❑Real property ❑ Annually/ ep obile home(IC 6-1 1 jf/2�
it any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income -; 4 e. and portion ^
of the property utilized to produce income r• : ..-
aU — D -1 _..(2 --k lDE) - OrZ)3 . ci-1-7-01-7 • A�
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vacating a homestead?
❑ Yes No
s natur lei gpt
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street.city state,and ZlPcode) Address of vacated homestead.if any(number and street.city,state,and ZIP code)
U)a CI . !sd • �K"OL1n ' CfJ : . "--E-1 LPL).4::\
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements Other land (2) ';"�•y4F
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) , '-,,- '' .:
annually assessed mobile/ - - - - fk�
manufactured home Garage (5) - .. -
Other Improvements (6) ` '4"M . '"t
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
1 hereby certify the above Is true,correct,
of Assessor Date signed(month day.year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day.year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date sign (mont day.year)
‘tsiNC ;..0 IIN.C3a_jd) a ...,3 col-4,-,...1)/ ,,,-„N„,..D.
Lt
R,
...c),,-2....
DISTRIBU ON: Original-County Auditor.File-Stamped Copy-Taxpayer
Page 1 of 2