Mobile Home_Clay CLAIM FOR HOMESTEAD PROPERTY TAX -�� FORM YEAR
„'t ` ' STANDARD/SUPPLEMENTAL DEDUCT V% in OR
'„+;_. ,. State Fonn 5473(R13112-09) �DD^^ 1"
S '- ! Prescribed by the Department of Local Government Finance r10\4
INSTRUCTIONS:See reverse side for filing instructions. ‘`NO 1 l tC�.��
' ,Tr;y7} ;, 'n:•�F , ? CERTIFIaAl ON)STA_tEMEVTr�r�,r ,vv ;'v�4is- 33 _zv lift a} s "i
I(We) ��!'1.nI d;! --. NI• certify that I(we)occupied as my(our)principal
place of residence or .i (are)buying the fl wing described real property fo/L . omestead Property Tax Standard Deduction is hereby claimed
r contract on the d-te this application is filed, G`tl (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
❑ 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 the shareholder, partner or member of the entity that owns the property.
x�< Y :.3 �Iri_wr' .,-yam .rsp� yr_-,.. N.. •rte.. - -.a - -Yr w..-.
�7= r"'ryr�`t-:m �r�:�'tSsak?J:�.3i�iLFa�"�:Y.cC�IMANTsS�I. FORMATION�ill �3�iog�'•� 'twr ,�'�,E"d"�. .L` 'a ZL..�rIgriY
Name of claimant(I I me) /j /
Name of claimants spouse(legal name) ��//
Social Security number of claimants spouse(last five digits) Drivers license I Identification/Other number Issuing State
of claimants spouse(last five digits)
4-' Yris �..p®+aes��raa.� •ad 'L'm >.};a KY ra SSs �ri^��v'+t,
'_- -fM fax "a,+y? ".`.t"�-A25.- TNo LA- '-CONT(relei ECORDED.,°' jas. '3'�x,.x.+c caF.t� 11.1.,41,*-1 ,"-.s+s
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
r . :ea N•;n: •.n :g f .L O t'r t- C .._.•r i. t -fl:. ..tom 4 �i..yra
". ,����;�s 4 t,�e�,�t�,..,�,�;zy;+ gg�ROPERT;Y OESCRIPTION�;m�4.t4•'s..t�:;ri.;.:"+r 5s.Kr`i 's .S?�='L�.-'a^�- `�..-tea
County Township Taxing ( t township)///,,..eA
Parcel number Legal description Is tfh"e".pyaerty in question: �-1
y19" 90o '97 j2 ("/y-P L lE1'^nnuafiy assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
4 /yx7d
i"e jai t IV:4 -S E CI I- .1Y:OWNEDj6y CL7NITR FICOTTER'COUNTIESj '}af .as< rwi''rs!i-tvmPill t •
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature f claimant /1
• . - (nu r sheet,city state and ZIP code) r �/CIP-
' �1.• __ A Ali �0 A. - I I / /
r grzow y r -at• •-s to {'�s+ioj t � rf.r. :?$jlaR� "' et ESSED VALUE)A'IiOMESTEAD 1P„,i NON RESIDENTIALik
fie. ASSESSOR_. !ON y4•'' A r� 11 TRUE hrAx.y LUsE. MATU110./a OFaTrT,V,$lr raVALUEz'3 fire. dk-i r.+.4XVALUE31 3 ML
Land not exceeding 1(one)acre Immediately (1)
surrounding residential improvements.Other land (2) - -. 0 -f-
Total land(line 1 plus line 2) (3)
Dwelling (4) ' ‘.4:::_i- y1 c F,:.
Residential Improvements or Annually
Assessed Mobile/Manufactured Home ' .i r''k. ..' 4' 'a-1'-
Garage (5) ?” _ Er _c :k ,:
Other Improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pis line 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Veifying action-Signature of Auditor Date signed(month,day,year)
3 • •i a•i .r?gi'. 4`i._ r 1-^n• }ta. -1 -.DARDrtDEDUCTIONALLOWANCE' t {•'+e�'� STARE r'` eF ,`
`�Z'`:'Sa_ .m J _sms.:n�. -> ;�...�-:�ch..uZT'1tc�-fi�.ta.trn-F`� ,.
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile Lame that is ?,\\$
$
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
one-haf(12)of the assessed value of the mobile home or manufactured home.
imr Date signed(month,day,year)
Signe