Mobile Home_Benton "'. CLAIM FOR HOMESTEAD PROPERTY TAX 4:m YEAR
STANDARD/SUPPLEMENTAL DEDUCTION
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Sr• State Form 5473(R12/6-09) )., i H 0 ■
�,�„7 Prescribed by the Department of Local Government Finance [ :Mr • I
INSTRUCTIONS:See reverse side for filing instructions. . • MAY 6 2U10
�. .. •� - d ; --ij` - CERTIFICATION STATEMENT _ _ 1
f
I(We) .ra�//iS:1�� erII1!F 0 certify that •49 • . y(our)principal
place of residence or am(are)buying the following described real property for which a Homestead Property�I , gSidtsr vloAtloypeigr claimed
under contract on the date this application is filed, (date of filing):
❑ I(We)own ❑ Am(are)buying under recorded contract
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation s„•,
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
. - - CLAIMANT'S INFORMATION
Name of claimant(legal name)C^ �/\[,
Social Security of claimant(last As dgls) Drivers license/Identification/Other number Issuing State.7-70 -
395 of daunant(last five digits) I /Gb•f\
Name of claimant's spouse(legal name) �(/
Social Security number of claimant's spouse(last five digits)I Driver's license/Identification/Other number Issuing State
of claimant's spouse(last five digits)
- . CONTRACT RECORDED; -
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
- - . PROPERTY DESCRIPTION. -County Township Taxing district(city town,township) �f��,}�,,
ly 7 ��-. �✓v-"
P -r.-n`number 7 Legal desorption Is the properly in question:
• `,, Yb/-oO/ 7 /.� L]heal property ❑ Annually assessed mobile home(IC 6-1.1-7)
®
If the portion of the¢�produce income.
the land not exceeding one(1)acre that Immediately surrounds that structure is used to produce income.describe the use and portion
. PROPERTY,.OWNED BY CLAIMANT IN OTHER COUNTIES •
County I Township County Township
I hereby certify the above statements are true,correct and complete. i natu .of/.imam- n
Address(if a ti street, s end ZIP )
'ASSESSOR USE ONLY I TRUE TAX VALUE I AAT 100 h
SED01.F/ALUE I HOVALUEAD I NON VALUE-RESIDENTIAL
- .Land not exceeding 1(one)acre Immediately pd=,-yx.f fi, gtr ,a.," i r}`¢y -i,.'
surrounding residential improvements. (1) - ---- "' #r `z- -`--^u
Other land (2) 7� ;� c;ye:s-;.-. -
Total land(line 1 plus line 2) (3)
Residential improvements or Annually Dwelling (4) } ,dFy,.*tp r,,,,, k`;F„X.'=,
Assessed Mobile I Manufactured Home --\4. rR<IS�sa, a -nit :
Garage (5) t " '^ s -sf r4'ia..
Other Improvements (6) i '=r'.i y rS_,z'A'-t
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 Assn-sot Date signed(month,day,year)
,f Iand complete. I' \_` \\\� `� I�
Veilying action-Signature of Auditor '\1)( \V\ \ l Date signed(month,day,year)
`. - _- •_ . - _ •STANDARD DEDUCTION ALLOWANCE • -- . • , .•
20 pay 20 Lesser of 60%of the assessed due of the homestead or$45,000
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 reel property or toe 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.
121111rA (0.-Ay
'3Tjn NMltor J Date signed Lr :: 4^y,y7O ___