Mobile Home_Williams (7) / g CLAIM FOR HOMESTEAD PROPERTY TAX ( YEAR
� STANDARD I SUPPLEMENTAL DEDUCTION FORM I(
�. State Farm 5473(R15 I S-14) HC1
\ Prescnbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. f1 j�
NOTE:Telephone.Social Security,drivers license,state identification and federal identification numbers are confidential under IC Si.
_ _ r...-c_.•-..
' _CERTIFICATION STATEMENT ;_;__._ _
I(We) /ri /&I-//-,n dr Qi certify that I(we)occupied A4• (4w)Pr'gqpp��qq 831�t
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Stfrk
Deduction is hereby claimed on the date this application is signed, (date of s •re). I(We):
Own. ❑ Am(are)buying under recorded contract. (ejlBI
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. SON COUN A"N
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residencetl�.DljoR
❑ Am (are)the shareholder, partner, or mem or of the entity that owns the property.
>.'- -
It buying on contract,Fee Simple owners name
Recorders g°re where contrast is recorded Record number Page
N v.-''.:_ _ . - > ':!` ._."PROPERTY DESCRIPTION _ 3.,-�.. s_ ':w�•n.kt TS'
Count Township ==2
Taxing d:'.l(city.bon,rover hip)
Parcel number II�Leen03l des'or^pt+onn ' I��\the property i testcn:
I/ iL/ /4.I i9- 3-,'� I yea' ty ❑ dy a mouse home(IC 6-1.1-g
I.any parson of her • naal s..NCNe or the and not exceed.g pie(1)acts that immediately surroU'Os_that s'SJCnre l5 used to produce income,desoibe the use and pardon
of the property trio podia"'sonic. •
at'- 0,7/-9ca SZ- CO
Is claimant vacating a homestead?
❑ Yes ❑ No
ISgne f daimarrI
I hereby certify the above statements are true,correct,and complete_ NI p 1 1I
Address of contact(number and street.aty,pate,end ZIP rode) /Address of vacated homestead,d/any(number and street,ay state,and ZIP code)
l‘i Sqf 3 S. 1 5' 2IisT' I D&wA✓sv,i e -1W L17665
Land not exceeding one(1)acre immediately . 111) I
surrounding residential improvements
Other land 10) I. _— __- I
Total land(line I plus line 2) I(3) I
Residential improvements or Dwelling I(4) I
Annually Assessed Mobile/ - --' '-
Manufactured Home Garage I(5) _ _ -
Other improvements (6) _ I
•
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month day.year)
and complete.
Veering action-Signature of Audh;p Date signed(rrani&day,yeah
=r . _.v_? s. <`_ .STANDARDDEDUCTION ALLOWANCE "'-e"�- � ?.:s,±=t'.
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 6-1.142 to a mobile home $
that is not assessed as real property ono a manufactured home that is not assessed as real property may
not exceed one-had(1/1)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date Signed(month day,year)
DISTRIBUTION: Ongthal-County Auditor.Fie-Stamped Cony-Taxpayer