Mobile Home_Dillon (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
.y.-.„,,,...t..` STANDARD/ SUPPLEMENTAL DEDUCTION v FORM
..��" State Form 5473(R13/12-09) HC70
a" Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS:See reverse side for filing instructions. 1 \
r�cr°„ '� ''Y'i r<`z. '`n" i'''"'� f3z'� ?�i�'G�'CERTIF.ICATION!STATEMENT'Xiw°':-�,�,n_`7ty.w. `✓.�'.E,..'tc�.�'.a�.. �. - . i i - .
.a ,� ...._lei.eoi../�`x�+xl....�.:.-?d.�?':x_,.6.s� _ + ra_ �.._.ic s- .w--,_s.:,
I(We) �//�!�/O YY/ai - certify that•L4wr upied as my(our)principal
place of residence or am(are)buying the following described real property for which a Homestead PropefISix k&idard Deduction is hereby claimed
ter contract on the date this application is filed, (date of filing). I(We):
C�'4�µ v
Art1(are)entitled to occupy as❑a tenant-stockholder ho der of arecooperative housing corporation GOVNSY FkO° OR
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a quei(frsonal residence trust
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
.E a+. t ...�ri?4'r' a.Wil&+.;,ip 3 ki'E '.y. ,i4 CLAIMANT S;INFORMA tail ,l.'.13%_`*�&cs.:ier is XS. .._-r rwFA -S: .LA
Name of claimant(:•. : :)
44,C,tQ I f .� / /is
Social Security number of dai ant's spouse(last five digits) Driver's fcense!Identification/Other number Issuing Sate
of claimant's spouse(last rive digits)
}--T• tb r '?i r ;i1- f y_ xd .is,y it h �!'f'CONTRACT RECORDED'Y {a..r_ r r .. -n K t•P i{!il.4` r 2:14.1'..;_.,nw l.:5
i..�:t:� .ii>w t.m:.,c .{�,..-.r`,i. .>tif.t{"<.'.a:anv > £iRi LS r.�...-�.:�t .... _ d .
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
.41:lS`:&t,�'twr_ n .;!;twr 4.1.:w;fas, d-'t, ..n:'d..$.-''.ft2PROPERTY DESCRIP•TION risk+i:.�i:,s E-a-7rvRrt`.e iii '`teggt T CCIF: k>_.:&—
County Township Taxing district(city,to• ,to ship)
Parcelll;umber 1 .-I description I Is the property In question:
//_—43g—coo 75 0 ms.I property ❑ Annually assessed mobile home(IC 6-1.1-7)
If airy portion of the residential structure or the land not exceeding one(1)acre that immediately sumxrn.. I :t structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
® / 995 G (h--rxxnr
S rr:'s.,z.,q o :t,-,^ ti: :-ikon ,::;r 'PROP, -o•t:t OWNED BY CLAIMANT=IN OTHER'COUNTIE ;-wxfig m,s5::big:.;.;,d-,`, T`;,rr, Lc z;:mi:
County Township County Township
I hereby certify the above statements are true,correct and complete. 1S'Qna°'r°of claimant
Address(number and street,city,slate,and ZIP code) !_
,:_. ar J • J LO
a r 's r a a>•.a t r /v ' r Y ASSESSEDVALUE,I`-WIOMESTEADt s):T� NON RESIDENTIAL .;i�
c.-jc-n L,�ASSESSORrl1SE.ONLYrW .. 1stTRU�TAX VALI£E r1_AT.i100 ro OF TTV4;(„4.-..•,_VALUE k C -'Yc. _.Es-VALUE. t-et: ?:
Land not exceeding 1(one)acre Immediate uc t - 3n
surrounding residential improvements. 1) � = +• --��+ r
Total land(line I plus line 2) (3)
Dwelling (4) `a 'bi i .'s
Residential Improvements or Annually
Assessed Mobile!Manufactured Home Garage (5) -'i R-s g i.40g-a'-Ef. ^:Y''
-.
Other Improvements (6) '�d`a. d?v,F:
Total improvements(line 4 through line 6) (7) ,\)\ rh --
Total value (line 3 pits line 7) (8) \ \ \ \'
I hereby certify the above is true,correct,
Signature of Date signed(month,day,year)
and complete. \/\\‘(1
Verifying action-Signature of Auditor Date signed(month,day,year)
`® ' .:Z a)7'r se +n .:l e.a. ,'rvS'`JSTANOARD DEDUCTION ALLOWANCE Shag"lea-..,Z:::.J - ._tLi.ait a' y"ir +:,phi.'
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
If(1, of the ssessed .lue of the mobile home or manufactured home.
hrte o Date red(rranth day,year)
(