Mobile Home_Brackney I "'" CLAIM FOR HOMESTEAD PROPERTY TAX p YEAR 14 j
. STANDARD/SUPPLEMENTAL DEDUCTION 1@ 1 ORQ
S _ State Form 5473(R12/6-09)
•.� Prescribed by the Department of Local Government Finance 1 /
JUN 2 2010
INSTRUCTIONS:See reverse side for filing instructions.
/- •
I - - _ - • - • .CERTIFICATION STATEMENT. '¢° - -
I(We) _a - /Ln 4 ceftmaIDW I ce i 'L9(our)principal
place of residence or (are)buying the following described real property for which a Home-/-d Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of fili g):
❑ I(We)own ❑ Am(are)buying under recorded contract
p 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 residence trust
- - . CLAIMANT'S INFORMATION
Name o Mani(legal name) _ x
of claimant(last five d' )
1 4 oDf river iP.-(rilase s t/f oa endtfg tion(Other number Issuing State
5 Q O s O Q i V N
Name of claimant's spouse(legal name)
Social Security number of claimant's spouse(last five digits) Drive license/Identification I Other number Issuing State
3 8 5 33 of d ant's spouse(last five digits) 42 A y/ _4
- - , - - 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 Ta (city,town,township)
Parcel number Legal description JL,weirstasielinlits Is the property in question:
191 I Iv ‘67 ❑Real property Annually assessed motile home(IC 6-1.1-7)
(. any portion of the residential structure re or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
, the property utif¢ed to produce income,
?4 - 4o9 — 000 7y -v0
-. PROPERTY OWNED.BY CLAIMANT IN OTHER COUNTIES
County I Township County Township
I hereby certify the above statements are true,correct and complete. nature of a.
Address(number and street,aty,state,and`P...e) -
PIoCI A c, An 414,o-‘7 bS9(194 4- XN x(7(739
ASSESSOR USE ONLY . ' TRUE TAX VALUE I AAT 1 0%OFATTV I HOVALUEAD ' NON-RESIDENTIAL
. Land not exceeding 1(one)acre Immediately - V Y.v �X is-3i-s surrounding residential improvements. (1) ° Q. $' ±�+, . ;} e-'
Other land (2) 6: ' 3 . :
Total land(line 1 plus line 2) (3)
Residential improvements or Annually
Dwelling (4) .Xi7 x ,E. <f-
Assessed Mobile/Manufactured Home
Garage (5) d "1S gl, ..cA ?....
Other Improvements (6) c'.., Sp.i .,.s-
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. ,,n11
_ Veifyirg action-Signature of Author a \� \�1 \' 1 \ % Date signed(month,day,year)
(10.. - - - - STANDARD DEDUCTION ALLOWANCE `
•
' 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 6-1.1-12 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.
•
Sigruw of Auditor yr / - Date signed(month,day,year)