Mobile Home_Douglas (2) •
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a. CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
; �` STANDARD/SUPPLEMENTAL DEDUCTION , ` H R
State Font 5473(R12/6-09) V
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for g instructions.
I
filing
CERTIFICAT!CN STATEMENT
e) l J'L��► 71�_� y ,,W certify that I(v1.e1�Loro ed1 asEv(1oiur)principal
place of residence or am A4 re)buying the following .-.ed real property for which a t mestead Property Tax Standatd De i tton's"tlEFeby claimed
under contract on the date this application is filed, (date of filing): ``�y��,
❑ I(We)own ❑ Am(are)buying under recorded contract ®'(H ,Tr
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation OIBSON
Have a beneficial interest in the trust or the right to occupy the roe Gf�UN7Y AUDITOR
❑ py property iffy under the terms of a qualified personal rest ence trust
CLAIMANT'S INFORMATION
Name retaimant(legal na )
r\�\i\i1 XQ
Social
If buying on contract.Fee Simple owners name
•
' Recorders office where contract is recorded • Record number Page
PROPERTY DESCRIPTION
Cott I` , . Township Taxing district(city,town,tC
• rya1 num r Legal description Is the property in question:
- f �+ 0 Real properly �,Annuae mob
le assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land exceeding not excee g one(1)acre that Immediately surrounds that structure is used to produce income,describe the use and portion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES .
County Township County '� • TownsNp •
I hereby certify the above statements are true,correct and complete. S' nature of nt l I \
1 Y/nlA_ `IJJJIi14
re ss n bet and street,dry, ,te and ZIP code)
0 - a-. t -L . ct -, c� N LI 1 o tj •
I !ASSESSED VALUE NON-RESIDENTIAL
ASSESSOR USE ONLY 1 TRUE TAX VALUE i AT 1006/0 OF 7TV I HOMESTEAD VALUE
Land not exceeding 1(one)acre Immediately gel i -�,,`tgl� -4— W
surrounding residential improvements. (1) sue .-xi1L1 sz ,� :rt_at,.
Other land - (2) :<tY+. �
2r S-
Total land(line 1 plus line 2) (3)
Residential Improvements or Annually Dwelling (4) ' .4%s"r'sE:Eli `�""y..`;ii
-+-t .�.6' ..SEtT.YII.K_S +iY:,f£si
Assessed Mobile I Manufactured Home ` i T V�_;. ft * •
Garage (5) r 3r 1 tl,i:e nso#.:
Other improvements (6) f.{,., gr 3 s:
t.
Total Improvements(line 4 through line 6) • (7)
Total value (line 7 plus line 7) (8)
hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
I and complete. \ r
Veifying action-Signature of Puduor Ii Kb' \l \\ 1�I ' V Date signed(month,day,year)
® STANDARD CEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of th- a c csed value of the homestead or$45,000
Notwithstanding any other provis on,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
)of the assesse�dd value of the mobile home or manufactured home. �/,o�ood y�/,aq)
Sig u of !,L (s-Y.h�/^ �/ ayi V u-