Homestead_McKinney ,f,-.,:c.?,-.4 CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
°i L STANDARD/SUPPLEMENTAL DEDUCTION FORM `'
a State Form 5473(R18/1-20/ HC1() ���{
�`,�� 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.
� M CERTIFICATION STATEMENT
PI
I(We) a 1"( • _ certify that I(we)occupied as my(our)principal
- place o -sidence or am(are)buying •following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date is application is signed, (date of signature). I(We):
I
XOwn.
❑ Am(are)buying under recorded contract.
jAm (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
1 ❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
j ❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
CLAIMANT'S INFORMATION
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
jRecorder's office where contract is recorded Record number Page
t
PROPERTY DESCRIPTION
•County Township Taxing di tnci.L5j( town.township)
^,1FSo n 02 ( y••-\ t\/l,
Parcel number Legal descnpticn IrrrQQQQQQegryryqryqr�r000000petty in ques.on
I Iseal property ❑ Annually assessed mobile home(IC 6.1 1-7)
r If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrcu ds th t structure is used to produce income.describe the use and portion
I of the property utilized to produce income
2C _ \2 -0C _ i00 _ dot - (Al ` -OZ9- .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
i State County and Township Is claimant v ' g a homestead?
Ei Yes No
Signal e f claimant
I hereby certify the above statements are true,correct,and complete 1
Address of contact(numb�treet,cite state.and Z"�coQe) ��\ Dill
of vacated homestead.if any(number an street,city st and ZIP code)
ZZ` JJv)V`Dt d J 1-'l �{
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately -f "
surrounding residential improvements _ (1)
I Other land (2) '�' .+ <E ' 1'
1 Total land(line 1 plus line 2) (3)
i
Residential improvements or Dwelling (4) Nye - .9.:.;.f. ti i( t
annually assessed mobile I
imanufactured home Garage (5) I A/�a :_ .
Other improvements (6) ,r'; 13F 1
i- 6_ZQ�
I Total improvements(line 4 through line 6) (7) _vim 7
I Total value (line 3 plus line 7) (8) C1/
SignatureofAssessor Utir (month day year)
I hereby certify the above Is true,correct, CO ,Y
and complete. Tvd,�,�^/�-�
Verifying action-Signature of Auditor Date siifiN) j4 day.year) 1
rY1
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000.
I
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 oft home or manufactured home.
Signature of Auditor Date sig (month day year)
on\ 6 • I ik IG ?o2�I
DISTRIBUTION: Original-County Auditor.File-Stamped Copy- aver ,
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