Mobile Home_Burkett s_ CLAIM FOR HOMESTEAD PROPERTY TAX FORM / YEAR
rt,„"_ I:'1+13 CREDIT/STANDARD DEDUCTION HC10
:-: 0:i State Form 5473(R817-07)
�j
Prescribed by the Department of Local Government Finance
L.o� r'R TIONS:See reverse side for filing instructions. -- . CERTIFICATION STATEMENT' -
I(We) 4. 0 C
0 e,,,A. .tL certify that on the 1st day of March,20
I(We)occupied as o principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
(re, I(We)owned ❑ Are buying under contract
W Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a a tract.
- . - CONTRACT RECORDED - 1 -
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number • Page
- - PROPERTY DESCRIPTION I' -
County Township Tadng district(city,town,township)
r Parc number Legal descnitpr♦9cj Is the property in question:
rx6 04 00048 E� 7 \?Q ❑ Real property ❑ Mobile Home(IC 51.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that imm surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
- • PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - -
County Township County Township
I hereby certify the above statements are true,correct and complete. �Sig-nJa-tture oof claimant 1
dress(number and street. 1 . b • P,�u� iA
( city,state.and ZIP
1: 10(07 . S . T2► G ) 2c.Ie L_nn e )4+4o$5-raq oT/3'N Lf 7631
ASSESSOR USE ONLY • I TRUE TAX VALUE I ASSESSED VALUE i HOMESTEAD I; NON-RESIDENTIAL'
AT 100%OF TTV' VALUE 1 -
Land not exceeding 1 (one)acre immediately ,"j` ^F', 'Y't +; i-'
surrounding residential improvements. (1) J .x:a '�
Other land (2)
Tdal land(line 1 plus tine 2) (3)
Dwelling (4) r s ;_ =.,
Residential improvements or Annually z-?,i. es
Assessed Mobile l Manufactured Home 5°sa w i "� -
Garage (5)
4
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pis line 7) (8)
I hereby certify the above is true,coned,and Signature of Assessor Date signed(month,day,year)
complete.
Ve itying action-Signature of Auditor Date signed(month,day,year)-®` ' STANDARD DEDUCTION ALLOWANCE • - - - g - '
-"-ZD pay 20_ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011 /�
Lesser of 12 \ 44000 for 2008 pay 2009 41,000 for 2011 pay 2012 \ \ y I Ill
Homestead Valuatiorl� $�,v \`^\\ ` 'V
« ('�\ 43,000 for 2009 pay 2010 40,000 payable after 2012 'l\
Signature of Auditor r)r \ \ Date signed(month,day,year)