Mobile Home_Arrivette CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
€ STANDARD SUPPLEMENTAL DEDUCTION V \t\ HC10
^ fj: State Farm 5473(R11 3/12-09) I \ �
'Li- Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. O I Z /4 6 L(- L/7 8 p f/
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. `.tr -���'�. 'n,_•�i�i�,c,n:.��oyy�,r'E`t=�'f-riS�r`ERTIFICA TIONiSTATEMENT :e. '�1tY`„$ F��nY�ii �a�.`^. ::�'.�i r'-6„�s°.i'�S
1(We) II.i i/ I •. ! certify that 1(v�cipl as ni ( 1r)I r -I
place of re idence or am(are)buying the following described real property for which a Homestead Property Tax Stan D u on 5 eervb t•- •
minder contract on the date this application is filed, (date of.filing). I(We):
11 Own ❑ Am(are)buying under recorded contract JUN 26 2014
❑ 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 resid trust^
❑ Am (are)the shareholder, partner or member of the entity that owns the property. JT�IL, •.'•_7�'�`9w-'!!�
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� 'i't '?L�al's _f. . '1"r� ICN11 g'TrIr`e-`a°"�fi - ``.r •T 1:.i..'at }y 4r.Yk.;ky.'t c� k {'+ ra _
y�av,.'ys»ry,�iaR• ;a j ..f.�,atc�jc7;��� CLA1MANiTiS INFORMATIONSat33'}'S_"" s �L �uw'F.aaAid. a..�.;S�s#.Y,�a;fY,,-��-.->r.(+
Name of 'many(legal nane)^
CQ� •�_�
Social Severity number of claimant's spouse(last five digits) Dri ees license I Identification/Other number Issuing State
of claimant's spouse(last five digits)
-},, -cam r : - -� S tr'�" s. 'ism°aa.�s c-:� 5.'LT�.i•jNTRACT��-- RECORDED th �. t - - Aram
s�' �kr.��l'?i'h�`�°.-�� +:�L�•s'.s4�f - - � _3 �' —• �S' :. av�' -_r � &
If buying on contract.Fee Simple owner's name
Recorders office where contract is recorded Record number Page-y„;
a - e .3 a"- t i a_ ti .'>t.Pa e..e itraW-ar+t'i 1ACkt r_ likegq?..;
'v �y.ef &--.-.-°x��c�,�".,,xi,�f"�,�.�-"^�.- PROPERTY DESCRIPTION �st...�..--��F•�r.?tu:S.s3,3. ssL{i
County Township Taxing di— .. (city;town,township)
Parcel number Legal description /._9 Is the property in question:
.2 6 4?8- 005//- 0° / 173 /y 'LG7 ❑Real property ❑ Annually assessed mobile home(IC 61.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that imm tey surrounds that structure is used to produce income,describe the use and portion
akar the property utilized to produce Income.
IP
rd2a ri °i" g.gi sus- -, a POPERTiy1'OWND!eyiCLAIMA7[LN1OT•.,HER CQUNTIES''a. •`'Fts ^ronno i _i$, -
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of claimant
Address plumber and street pt,state,a •ZIP cod ) ' ^( /
!!�i [CI G / t Zia
r.,,xi •e"'z' 3 g ;L-4-v.N. r `•' TgSSESSEDiVALUE -aHOMESTEAD`r td NON REIDENTIAL-tt
a¢tom•ASSESSOR USE ONLY! y - �3•TRUEtTAX.VALUE x - r ' -47i. #sJ.::_.
.lass. n ,z;.,•.,:. .• �1,ilia -�., aF:i$ATI100°/,OF TT,Ve. `furVALUE:`d R :.'" VALUELt45
Land not exceeding 1(one)acre Immediately (1)
surrounding residential Improvements. - -
Other land (2) ,.-.tee, ,,
Total land(line 1 plus line 2) (3)
Residential Improvements or Annually
Dwelling (4) x`r ty S^
" � ') < i�
Assessed Mobile!Manufactured Home Garage 5 > -. 1 iti f ;:-/-1'M1}t
y R
Other Improvements (6)
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.
%Veilying action Signature of Auditor ` ` Date signed(month,day,year)
0 cig! t _ , RwTZ STDARD!ECUCTION a.OWAffFEi emu iZ 1.fL kWicni,i ;
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 o IC 6-1.1-12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
one-half(12)of the assessed value of the mobile home or manufactured home.
Signaw of Auditor Date signed(month,day,year)