Mobile Home_Ile t,_,
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
/ -' STANDARD/ SUPPLEMENTAL DEDUCTION FORM I
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y:.;r- : State Form 5473(R73/12-09)
y' Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
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�,`c�-Z -s'�' ��,,_;��__3 Yv,:g�t''��c,�'� C RTIFICATION�STATEMENT +�ffirf;,q,�i��a��,A���c�s.rfs '"`�.afC�c�`s"`"'^���
I(We) 5a imp P l i e - �3'�.�IIF.1! t� certify tf < www pt rn. .:principal
of residence or am(are)buying the following described N. pr. . for which a \ estead Property Tax tend t . - claimed -
contract on the date this application is filed, (date of filing). I(We):
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. , Own ❑ Am(are)buying under recorded contract MAY 12 2014
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 "dance
❑ Am(are)the shareholder, partner or member of the entity that owns the property. a OR
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, 'u.;.�,s �.uxr~�.'L9°aft_..7+5 =31f. c ':.�'- `cftS, CMANTyS INFORMATION -F.2W.4i ,u_ax�.Fr .. `?s.x.`;€.'�'si ,e:. -u.,...s=...L^3i
Name of claimant(legal name)
Sate Z 12 S�e
Social Security number of claimants spouse(last five digtts) Driver's license I Identification/Other number Issuing State
of claimant's spouse(last five digits)
Kit •trtt.'r liiii.: ltd _3.._h-~",`';'`tOa 4, X CONTR Chi CE ORDEDT'`ilzaa 'b +z r'l+.'rr��"�3 f,:n , .T,3.-..-an w., ;:*d;
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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Township - Taxing as (city,town,rv�.nship)
/i46fi-e K/ Ver z .
•• number L .I description is the property in question:
- b—y I S -0 5003 -et �99 / ❑Real ProPerly 'l Annually assessed mobile home(IC 6.1.1-7)
If.aaaaa�����portion of the residential structure or theta • not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
ortY utilized to produce income.
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W; .- "7, .,,A' 's" 414.:"'"3,j ePf0PERTYbOWf∎I 6 jCL ANTLINOTHEI2iCO ktlESaa0;1jf' .t-a.¢..,s�;._�4keit}tz
County Township County Township -
I hereby certify the above statements are true,correct and complete. Signature of claimant`
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Address(number and street city stare,and ZIP code) /� ' '
W ar i A dr /:a_ s •1i. .
tr.: nr-a.;'p-A-cf n. - tst + iiinte" +j'1.--i n' r W 9ASSESSED VALUE I: HOMESTEAD �7 yPJON RESIDENTIAL7' y 'l'
` r 4 ASSE`SOR UU3EONL Ttktru io- UE�TAX Vimia.sATd100,°/1'OF T,T1/'avai aVAinic, K':tzk--@mLUE <c A'
Land not exceeding 1(one)acre Immediately (1) v -
surrounding residential Improvements.
Other land (2)
Total land(line 1 plus line 2) (3)
Dwelling (4) :"..t.,:1-•':_t-4 ,Iss r .x -F-°
•Residential Improvements or Annually ., ;.
Assessed Mobile I Manufactured Home Garage (5) t _ +r ` - ;?:
Other improvements (6) - -_ -
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor •r)1 4..I Date signed(month,day,year)
and complete. \\ / \ ` ,p
\ \')` Date signed(month,day,year)
V +g action Signature of Auditor � d
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20 IL{ pay 20 15 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(1R)of the assessed value of the mobile home or menidaUUred home.
Signature of Auditor . Date signed(month,day,year)