Mobile Home_Dersch ' M
"" CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
VSTANDARD /SUPPLEMENTAL DEDUCTION F_�
State Font 5473(R12/6-09) n1:10
y„ Prescribed by the Department of Local Government Finance 1
INSTRUCTIONS:See reverse side for filing instructions. • FILE
•• ■■ CERTIFICATION STATEMENT
• I(We) ��r7 LAIrilirIP certi that I(we)occupied as my(our)principal
place of resi.-ice or am 0.)buying the following described real property for which a Homestead Property Tax Stand9d duction is hereby claimed
under ct on the date this application is filed, (date of filing): "vyy`/?7CS
I(We)own ❑ Am(are)buying under recorded contract 131BSON COUNTY •AUDITOR ,
Ei Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
.CLAIMANT'S INFORMATION• .
N. -of claimant(legal naniel "
Social Security number of claimant's spouse(last five digits) Drivers license/Identification/Other number Issuing State
of claimant's spouse(last five digits)
" CONTRACT RECORDED
. It buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number I Page
. - PROPERTY DESCRIPTION •
!///coon OS-00i\ Township /� /� Taxing district(city,town,township)
�X 4- s Yn r -DO Legit clonal / - r I Is the property in question:
(—/J` Real property 0 Annually assessed mobile home(IC 6-1.1-7)
•If any portion of the residential structure or the laid 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - , •
County Township County mxR'� /ip \ .-
I
hereby certify the above statements are true,correct and complete. t ""a tit ail f ` �� (
\/ •
Address( •-r and street,city,state,and ZIP code � `7�!/'--v_ B
r - CL •
;X•; ' ASSESSOR USE ONLY I TRUE TAX VALUE-I AAT 100° OFATTV I HO VALUE AD I NOi. VALUENTIA
Land not exceeding l (one)acre immediately �� aa ;"y-.t ,,a 'ar-g-Q :�r' }'�3--
surrounding residential improvements. (1) /- 4 `O \ SA'=s..tU3° �:PL:>t
Other land (2))7 H
n r 1 {-�. }.r. ^\,y1
Total land(line 1 plus line Z) (3) \, k rat / V
Residential Improvements or Annually Dwelling (4) C _y}ki /� I\\0r xSv' st r 7.' A
Assessed Mobile I Manufactured Home Garage �5 �` \�l �/ Slw T' \°C�,Y �'`�' >
L c
Other improvements (6)\ c ` .n z3
Total Improvements(line 4 through line b) (7) A
Total value (line 3 pus line 7) (8) V
I hereby certify the above is true,correct,
Signature of Assessor \ Date signed(month,day,year)
and complete. l
Verifying action-Signature of Auditor 1 \. \I \I\� \k\ Date Data signed(month,day,year)
`I�1`f .•STANDAPD DEDUCTION ALLOWANCE .i
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 �I rs .
Notwithstanding any other provision,the sum of the deductions provided in/C 6-1.1-12 to a mobile home that is $ \ \
not assessed as mat property or to a manufadumd home that is not assessed as real properly may not exceed
one-half(12)of the accessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)