Mobile Home_Dougan •
ra CLAIM FOR HOMESTEAD PROPERTY TAX I ( YEAR
'e STANDARD /SUPPLEMENTAL DEDUCTION J . FOR,, ii
x .'- _ State Fonn 5473(R12/0-09) • /1. t 1 ii
ry a Prescribed by the Department of Local Government Finance
111AUG 3 0 Lulu
INSTRUCTIONS:See reverse side for filing instructions.
• r . a
L/ v
I(We) G{@rge Wt6t]b3reactlpidUbefid`y(our)principal
place of residence or am(are)buying the f [lowing described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contrad on the date this application is filed, (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 t
CLAIMANT'S INFORMATION
Name of claimant(legal na ) //
/HQ,-)
Social Security number of claimant's spouse(last five digits) Drivers license/Identification l Other number - Issuing State
of claimant's spouse(last five dgits)
CONTRACT RECORDED
If buying on oorinac.Fee Simple owners name
Recorders office where contract is recorded Record number • Page -
PROPERTY DESCRIPTION
County Township Taxing district((ci¢,�to(wn 3nship)
1l/ �!t/ i
�'�'-)�/f/�P n mbar ���? Legal description Is the property in question:
l_l'V� (O-W�Q co / / ❑Real property ❑ Annually assessed mobile home(IC 6-1.1-7)
If any portion of are residential swcbire or the land not ug one(1)acre that nunedwlely surrounds that structure is used to produce incase,describe the use and portion
41 of the property utifaed to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township - County 1 Township
I hereby certify,�th/e above statements are true,coned and complete.
Vrreature of daimon ,/)
Address
/D f/(number W �s Q..1e,and IP codJ of 3 -Y-t, 4 i ...e, /7/// //✓/ /
a y v g---
ASSESSOR USE ONLY I TRUE TAX VALUE I ASSESSED
100%OF TTV HOMES VALUE AD I NON-RESIDENTIAL
Land not exceeding 1(one)acre Immediately ty � s '� L 'y "
surrounding residential improvements. (1) -. i-r» : i$: -M
fl
i r.�_tf
Other land (2) t i4f-{47441 `5 •
Total land(line 1 plus line 2) (3)
Dwelling (4) -?' "a, 1s-_ .R.
Residential Improvements or Annually '�"£'�` ss- f` ,. ^
Assessed Mobile I Manufactured Home Garage ^ e-F t y 34 TT:
(5) FA.r1Par9hr -TS, ., ,; T=
Other Improvements • (6) =Y?� �• „1.:* '
Total Improvements(line 4 through line 6) (7)
Total value (line 3 pas line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete. t��{� v, (�
Verifying action-Signature of motor - , \ J \µ \'\\ `\ ` Date signed(nronth,day,year)
STANDARD DEDUCTION ALLOWANCE
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 Palter Data signed(month,day,year) '