Homestead_McCoy (4) N.. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
°i STANDARD/SUPPLEMENTAL DEDUCTION r FORM n^
State Form 5473(R18/1-20) L HCIO �'C..!Z4
}• 14
�C,:-• 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.
CERTIFICATION STATEMENT
1(We) Ink' lir . i J_ . • certify that I(we)occupied as my(our)principal
place of reside e or am(are)buying th- .11. ing described real pr.p i rt under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the dat- .-application is signed, (date of signature). I(We):
XOwn. ❑ Am(are)buying under recorded contract.
/❑ m (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.
IIf buying on contract,Fee Simple owner's name
I
i Recorder's office where contract is recorded I Record number .Page l
PROPERTY DESCRIPTION
County Township l Taxing strict(city town.town ip) '
I son ' 0 2i- __I v -"T�s _ __
~Parcel number Legal description Iteal
perty in estion
I property 0 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 surroustructure;s used to produce income,describe the use and portion
of the property utilized to produce income
2C— 05 —�0 S 00 — O0 l • L(03— 023--
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County.and Township Is claimant v. . ng a homestead?
❑ Yes ti No
Signature of claimant
f
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city state,and ZIP code) res d.d y u e d tr , at d ZIP cotle)
24 TS— N B t$11 Cn e)'1--�Yl-I-0-(.+0 .
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (i) '
surrounding residential improvements ''?ma��yy -'
Other land (2)
Total land(line 1 plus line 2) (3)
1 Residential improvements or Dwelling (4) k � C'iii1'it i.
Iannually assessed mobile I ''�P" "`x"���"'
I manufactured home Garage (5)
Other improvements (6) ...,. .:6. , . ..
Total improvements(line 4 through line 6) ( �`
Total value (line 3 plusline 7) 0 --1
I hereby certify the above is true,correct, Si Assessor 1pA7• I Date signed(month day.year)
and complete.
I Verifying action-Signature of Auditor CO 1 •- I Date signed(month,day.year)
1
STANDARD DEDUL riON:.'LOWANCE
w
20 pay 20 Lesser of 60%of the assessed value of the homesteQ9r'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 manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the m-• e or manufactured home.
Signature of lWdimr Date gned(men. .day,year
lg M , 32- 1u •
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-T- •
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