Homestead_McKannan (7) 0" CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(Rte/1-20) 11C10
Prescribed by the Department of Local Government Finance x
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.
CERTIFICATION STATEMENT
I(We) CkAarlYVIN certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property 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):
Own. 0 Am(are)buying under recorded contract.
D m(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
D Am(are)the shareholder, partner, or member of the entity that owns the property. '
...... .... ',:.f-IT- - '..--::: CLAJMANT'S INFORMMION•:.,!*.
(Applicable only if applicant' 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 --I Peg,
PROPERTY DESCRIPTION
County Township 0 0 3 Taxing district(city,town,township)
IParcel number 5
Legal description
I Is th p perty in question
1 ,,I sal property 0 Annually assessed mobile home(IC 6-f(-7)
If any portion of the residential structure or the land not exceeding one(I)acre that immediately s rr nds that tructure 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 Tovmship Is claimant V. .?g a homestead?
Li Yes vi No
/a
&oat e.f clai.a
I hereby certify the above statements are true,correct,and complete. - / / (7 i /460/2/0
Address of cont*t numgEr and steel',city state and ZIP code) Addres-of vacated homestead,if any(number at.street,city.state,and ZIP code)
Q1--•N \/N,NSI 0 n S--• VNP.ISTh-- le‘ -
ASSESSOR USE ONLY I ASSESSED VALUE 1 HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
-- - - •
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2) -s7)
1 Total land(line 1 plus line 2) I(3)
. .
Residential improvements or I Dwelling 1(4)
annually assessed mobile! c '\-----litt.‘ (0.
manufactured home I Garage
• • „
. .
Other improvements I(6) * ,
, . .
Total improvements(line 4 through line 6) I(7) ikto oc"
Total value (line 3 plus line 7) (8) 11.1fai &A-C
Signature of Assessor „pip". ,(Jo 'Date signed(month,day year)
I hereby certify the above is true,correct, sO
and complete,
O\C"1111
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 h - at is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mo r -o anufactured home.
Signature&Auditor , Date signe month.day,ye
I, ' 3 0 2.__. ,
DISTRIBUTION:Original-County Auditor.File-Stamped Copy-Taxp. Jr
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