Homestead_McCormack •
Ms.=�`*�4, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
s STANDARD/SUPPLEMENTAL DEDUCTION FORM
x` �'^"t t State Form 5473(R1611-20) HC10 f V .
°..^yea-v 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 1C 6-1.1-12-37.
CERTIFICATION STATEMENT //
I(We) Q\ I/1✓lrt,(j 11Y Jtw) S ‘
( I ICLe4ify that I(we)occupied as my(our)principal
place of residence or am(are)buying`ng th-following described real.roperty under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
O 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.
'
Social Security number of claimant's spouse(last five digits) Driver's license 1 Identification I Other number of claimant's spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number.)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
' PROPERTY DESCRIPTION
County Township ' Taxing district(cr.to rq tow shif�
0r2
��'1
Parcel number Legal description Is I e roped),in question:
I Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surr nds at structure is used to produce income.describe the use and portion
of the property utilized to produce ame
Z. -- ( 2- - o - �� 5�
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant va ti a homestead?
❑ Yes No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. /��,/s
Address o ontact(number and street,city,state,and Z,P code) Ad ess of vacated homestead. any(number and street,city,state,and ZIP code)
6 Z Cu3atl \ (-1-- 0— . ('
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not surrounding residential i one mprovements entsacre diately (1) f.1.'r
ot_;„:0 ,-.,-,
Other land (2) i t ';rya . .11;4
s, ,�. e r c:i..ua
Total land(tine 1 plus line 2) (3)
Residential improvements or Dwelling (4) J ';1 ika' •ca z r
annuallyassessed mobile 1
manufactured home Garage (5) A� r 'n ,.7
Other improvements (6) rK St jfry,,F,,3;A
io
Total improvements(line 4 through line 6) (7) Gj8, a
Total value (line 3 plus line 7) (8) CO Qrig 0
I hereby certify the above is true,correct, Signature of Assessor jh_•C`^ month,day.year)
and complete. 40 "• •
Verifying action-Signature of Auditor O,'gy Da a 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 S
that is not assessed as real property or to a manufactur-..•. = hat is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobil-ho 'e or manufactured home.
Signature ofAwditorr//, Da[e gnetl(month day,year}
23
DISTRIBUTION:Original-County Auditor,File-Stamped Copy- .'., ' :
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