Mobile Home_Powers CLAIM FOR HOMESTEAD PROPERTY�, /�/L�1j, FORM
.”.. ;i - STANDARD /SUPPLEMENTAL DEDUCTION 1.
v ' HC10
'ge(.' �" State Forth 5473(R13/12-09) f 5
•`7.-`_ Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. • \ y jj 365 �/1 1 O
- -... a -a,tc -.. .zre .,.w ..-�.. s f.. V t ar. ^rr, - �.-fy .y /3N ay.,:i-.p
-�,, ;,'-_6�':.cf� tdt`rt7�`,�z> �'�. CERTIFICATION,�S,T�ATEMENT�Y-y ,�,"4�'� '�.LGr;s-+sFc`9[t '��-�s:���,r..L
Y I(We) \in ��A !�„{y }� o ' pwQ��V certify that I(we)occupied as my(our)principal
Race of residence or a (are)buying the following described real property for which a Homestead Property Tax Stand 3u on is let- t
9 r contract on the date this application is filed, (date of filing). I(We): ��� r
Own ❑ Am(are)buying under recorded contract
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation APR 2 5 2014
❑ 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. • _i -xi
w;3 .a . y' `y i,`,y; .4 T• CLAIMANJeS[INFORMATION '"'- '"' 'i-`"r' r _ .Y.6Vaf";.Nf eS}.'l�it�1' 1 "!Y
Name of claimant(legal name)
Lin
Social Security number of claimants spouse(last five digits) Driver's license/Identification/Other number Issuing State
7..r of claimant's spouse(last rive digits)
-
CIO •€a;':k+S r'.u -fi y.?n�".,_ *..''*"•.dr.'r!tct 3" CONTRA O CE 0 2DEDfiY.as kr > ir,rir-_ siG i 43:;`i'roC`''l..'< '"Y-'t.
It buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
s2 ° " X'fft ilThitf','.�° is 121-P,ERT_Y DESCRIPTION T.F::::72 t3`t i-'.," . Vt.s.sr.°iTS_-t�"_31: 3ieeli.S..
County Township Taxing dis V (city,town,township)
.. U-Pe•.a.o-Cs•
Parcel number Legal description Is the property in question:
R1 -4 7-G'.-05 O H 6_ 3D LO CI Real property R Annually assessed mobile home(IC 6-t 1-7)
If any portion of the residential dential structure or the land not exceeding one(1)acre that imm lately surrounds that structure is used to produce income,describe the use and portion
of Lb roperty utilized to produce Income.
t i 'a ',7 li %K aROE it NTaYTCNM1TN OTHER COUNTES y y ft • J =`', Ym 44
County Township County
rS. r•-
T ownsship
I hereby certify the above statements are rue,correct and complete. S r nt 7L-
3 c maS „o O.R.t U .E'ONY y --, TRUE; I ATa100 o OiTV 3VAL( ax 2t VA UE s .:?ri,
Land not exceeding l(one)acre Immediately (1) ,r r.1>-,e," 't
surrounding residential Improvements. -
Other land (2)
Total land(line 1 plus line 2) (3)
D vellIng (4) R z k - y� t.
Residential Improvements or Annually
Assessed Mobile/Manufactured Home € r t, r ;•` -; ` )t
,
Garage (5) .;:r.'-'':::-.-4=> c Y . F-
Other Improvements (6) . ..-.,L'r.
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. k ✓Gl.
Verifying action Signature of Auditor
Date signed(month,day,year)
`Oman yr 44•-s .ali STANDAAR_O3D ED1,IKli fAL OWANCE_,a:-Sir K Mk tit1`
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.
Signature of Auditor Date signed(month,day,yeah