Mobile Home_Beel YEAR
r'gt. CLAIM FOR HOMESTEAD PROPERTY TAX FORM �
A STANDARD/SUPPLEMENTAL DEDUCTION I OR
e• State Form 5473(Rl2/6-09) I.
S Presaibed by the Department of Local Government Finance
—'
INSTRUCTIONS:See reverse side for filing inslrudions. } _ ,)
Orr CERTIFICATION STATEMENT. -
�� � certify that I(we occupied as my(our)principal
I(We) for which a Homestead A, t rtifax S16 Deduction is hereby claimed place of residence or am(are)buying the following described real property
under contract on the date this (date of filing):application is filed, 'et
(We)own ❑ Am(are)buying under recorded contract
El Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation teUtaUn�U be trust Have a beneficial interest in the bust or the right to occupy the property under the term&inggps
. . CLAIMANT'S INFORMATION •
Name f aimant(1 al namee (� -
�•�(.�
•
• •. •• •- Issuing State
Social Secod, number of claimant's spouse(last five digits) of claimant's spouse(Iasi five digits)
Other number
......' 11•411 CONTRACT RECORDED • -
If buying on contract.Fee Simple owner's name •
Record number Page
Recorders office where contract is recorded
i PROPERTY-DESCRIPTION., '
-- Township
County
rop�}y I Is the property N question:
P�'ina1 ber ODD% OD ..;, . .� . a ,. ' 0 Real property IJ ' .,
• describe the use and portion
/'S If any Pgrtion ofuN�e re�stWo p�uce inmme.the land not exceeding one(1)a'r that immediately surrounds that structure is used to produce income,/. r I of the property
', PROPERTY OWNED.BY CLAIMANT IN OTHER COUNTIES Township
I hereby certify the above statements are true,correct and complete. . • J
�s( { adstrait,rrll'srate; LP ) T` • *arty P n..ce+G Y/ Z►✓. T 2.6 20
- '. e { I NON-RESIDENTIAL ASSESSED VALUE -.HOMESTEAD VALUE
*ASSESSOR USE ONLY -1-TRUE TAX VALUE I pT 100°h OF TTV, - VALUE yU ; ..0 z ,r.•
— a T3..2 _ Ak- ti-v
Land not exceeding 1_(one)acre immediately (1)
surtoundine residential tm•rovements. - e: -- F F
(2). (3) setVi . ; tr tl-
1.
Dwelling (4) Y rx nt 3 e
Resldenual improvements or Annually a c-`� v-,}`- �
. �
Assessed Mobile I Manufactured He Garage (5)
IIMIZESI (6) —'
(5) Date signed(month,day,year)
I heand reby mple certify te. the above is true,correct,
Date signed(month.day yras)
1 Verifying action-Signature of 6tor ,'
1 �,• '• - ,STANDARD DEDUCTION ALLOWANCE -
20_pay 20— Lesser of 60%of the assessed value of the homestead or S45,000
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 properly
or m a manufactured home drat is not assessed as real property may not exceed
one-had(112)of the assessed value of the mobile home or manufactured home.
Date signed(month,day,year)
1