Homestead_McGregor CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
y -°%1�' STANDARD/SUPPLEMENTAL DEDUCTION HC10 p<oZ
State Form 5473(R18/1-20)
d. 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 IC 6-1.1-12-37.
,t�CERTIFICATION STATEMENT
t yM I(We) Geg • LeS/S( /-t!C f to 047,- certify that I(we)occupied as my(our)principal
place of residence otam(are)buying the foll0dring described realjN./roperty under Coco tra t which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, laiaI (date of signature). I(We):
ls Own 0 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.
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city town,township)
Cj•Oh 5 c)i\ C O i v M\J\o.._
Parcel number Legal description Is the prope,rty in Question'
OV+_1 3-?6-/00 CCO r 60-7 - Oc•Co PEr1sal property ❑ Annually assessed mobile home(IC e-1.1-7)
If any portion of the residential 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 property utilized to produce income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township Is claimant vacati a homestead?
IT] Yes Q.-No
Signature of claimant y/ .�y� _wya�(� '
I hereby certify the above statements are true,correct,and complete. Par-pc-el/T/'f rn (/Address of contact(number and street.city state,and ZIP rode) Address of homestead.if any(number and t city state,and ZIP code)
(0 s: e 0. S ie 1ga. 0 C( C O
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements -
Otherland (2)
Total land(final plus line 2) (3) _ Vir
—
Residential improvements or Dwelling (4) _ is.
annually assessed mobile/ -
manufactured home Garage (5)
-
Other improvements (6) DEC 2 8 2022
Total improvements(line 4 through line 6) (7) L
Total value (line 3 p1sm line 7) (8)• 4-.1'l_ i / � N O
-
Signature of Assessor t hAielLLGo ���((`
241)
I hereby certify the above is true,correct, GIBSON GOU
and complete. - -- Date signed(month.day year)
verifying action-Signature of Auditor
STANDARD DEDUCTION ALLOWANCE
•
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000.
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 signed(month.day.year)
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of 2