Mobile Home_DavisI.
' CLAIM FOR HOMESTEAD PROPERTY TAX ^ R YEAR
I STANDARD/SUPPLEMENTAL DEDUCTION I\ 1 I ry HC1O
t
! Sate Form 5473(Rip/5-14) `
l Presmbed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. ! ! I s
NOTE:Telephone,Social Security,drivers license,state identification and federal identification numbers am confidential under l r - .1- t-37: I,
NOTE:
�- ° "CERTIFICATION STATEMENT ' " - - 1- '-I • ' '-(, i•lib
i(we) i • certify that I(we)occupied as m y�(our principal
place of residence or am(are)buy g the following described real property under contract for which a Homestead ProgVitRa n t'
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
n. ❑ Am(are)buying under recorded contract. t
ai
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. �/41111r
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualifieers'aG Nreg TOIS A DITOR
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
- -CLAIMANTS INFORMATION.' . - __
Name of dainant(legal name)
1N1
Social Security number of claimants spouse(last f dgts) Dover's 5ceme/Iden:.5ra::on l Other number I Issuing Sate
of claimants spouse(last five dgts)
�:4' t '',s:_ ,:X.4ti CONTRACT:RECORDED -_"#; _Z ,.+ -..r-s"_ar- _'.t-*IYe'
If buying on contract.Fee Simple owners name
Recorders oSce where mmraa is recorded Record number 1 Page
`k4-S _z-« D " ;.-=: i-.a 2-111.- .2_-;:2C--7-1-_a-iPROPERTYDESCRIPTION"StL- -`rite ....a-3-.- ""0
County Township Taxing district(apt town,towvsh4t)
Parcel number Legal CesmG:ion I Is the proped in ues' �j
,AL-�l - O57)025•b I ❑Real prcpeny LT�muagy assessed mobile home(IC 5-1.1-7)
If any ponce of the residential=ochre a the land not exxedig one(1)acre Nat immediately surrounds that s:ni -Te is used to 11aoduce income.desmbe the use and oamon
® of the properly tarred to produce income,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is claimant vacating a homestead?
0 Yes fl No
Signature of m
I hereby certify the above statements are true,correct,and complete. , n �����/•��I
Andress of carae(number and street.sly,state,and ZIP wee) I`JAdd'ress of va ted homestead,don tuber and street,apt state,and ZIPcode/
7 L41 S 0 r 6
Land not exceeding one(1)acre immediately I(1)
surrounding residential improvements
Other land 1(2)
ITotal land(line 1 plus line 2) I(3)
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Vadyi g action.Signature of Audio, \I, ') I Date signed(month day.year)et.. r .3 1.s--='r STANDARDOEDUCT1oN'ALCOWANCE;- M: _ "�_--a•_ ' `&
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 toe manufactured home that is not assessed as reel property may
not exceed one-half(l2)of the assessed value of the mobile home or manufactured home.
Signahwe of Auditor ..-�} (1�1 Date signed(ran day,real
0 1c_5�1 .Z_S,i,e It �V l -aSJ-:�,
DISTRIBUTION:Original-County A W.:or,Fie-Stamped Copy-Taxpayer