Mobile Home_Burns ,nvP aY, 17 -l8 'S-a.a-r?
Mr4, , CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD I SUPPLEMENTAL DEDUCTION
State Form 5471(R15/514) HC70
Presorted by the Depadmem of Local Govemme'd Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Soda/Seard4,drivers license,state identification and federal idenfGxation numbers are confidential under IC 6-1.1-12-37.
• I(We) a certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, __-- (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contact
❑ 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 .
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
:u.s- - f.i ' 1: . s ::: 1v"?. CLAUMNT'SINFoW4ATONF _� . i .a.:- 3,C_:-. . ,1,C4_;
Na ' ant(Legal name)
UY
Name of claimant's spouse(legal name)
-
Social Seoaiy number of claimant's spouse(last five dks#s) Dm license/Iden3m.ian l Other number luting Sea
of claimant's spouse(last fire digt) 'I
_ CORD- €�' A.:p__rT4 -;t:—
l�'3�.ni•�_:ems..�'iF .ter �"� '�_- aCONTRACTjRECORDED0.� �'S!(y��n 1 _,r. ,.._. .. e
If twig on contact Fee Simple owner's name II�
MAR 9 2017
Recorders°Mee where contract is recorded Record number Page
i�s1
R.rr.`,3.re F- `. .+ATC1-124;i +V'au-&..7.c .ROPERTY,DESCRIPTIONWIS-- e'a lililtla9' a
Cor
1 y Township Taxing dsYVi(ciry.town.deostra,) GIBSON COUN ' •UDITOR
Parcel number Legal description Is the property in question ��
❑Real property ❑Yeasty asssed mobie home(IC 6-1.1-7)
• U of the residential sttcae or the land not exceoLg me(1)acre drat..-ledattely surrounds that sTlfae is used to produce income.describe the 3e and porno.,
® Of property N produce income.
07‘.-411-- W i qWa G
0.571.5
PROPERTY OWNED ELSEWHERE BY CLAIMANT ' _ .. , I
Sats,County.and Township Is claimant vacating a homestead?
. . ❑ Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. 0✓C1/fix
•..-of-' ,a (number end street city,state,and ZIP cone) .. -.of vacated hontead,if any(number end street cry,sate,and ZIPcode)
CO• CU. - ,. . .. chic Pa's e ... _A •T•'U u- ASSESSOR USE ONLY 7-7.-1 ASSESSED VALUE 1 HOMESTEAD VALUE- ' NON-RESIDENTIAL . ,'
VALUE
Land not exceeding one(1)acre Immediately I
surrounding residential improvements (1)
Other land I(2) 1 11
Total land(line 1 plus line 2) (3L•11',Y
Residential Improvements or Dwelling (4)" LlY ggg
Annually Assessed Mobile I - `
Manufactured Home Garage (5) I '-_ `_:±- p5
•
. -..}C
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pica line 7) I(e)
1 hereby certify the above Is true,correct, I Signature of Foessor Date signed(month,day,year)
and complete.
Veiyag action-Signature el frocUer Data signed(month,day,year)
_ - _ _ , STANDARD'DEDUGTONACCOWANOED
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 5
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not ex ne-half(1R)of the Lai luue ooff thee mobile homme or manufactured home. I
S :evre • - • '� Date signed —/ el
�at)
DISTRIBUTION:Orignal-Coady Audar.FieSemped Copy-Taxpayer
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