Mobile Home_Fougnies •
.---4.-f.- CLAIM FOR HOMESTEAD PROPERTY TAX / FORM YEAR
STANDARD/ SUPPLEMENTAL DEDUCTION
s "'"' '- • State Form 5473(R12/6-09) 1 `Mr) 70
.� �/ Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. MAR L22 1 2013
® CERTIFICATION STATEMENT
I e i .r a <4m/ft,[I(we)occupied as my(our) •principal
place of residen.j.r am(are)buying the following d- I bed real property for which an�H�ooqmCCeAf�t�a - • -A deduction is hereby claimed
under contract on the date this application is filed, (datEtllY103' :
0 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
CLAIMANT'S INFORMATION
Name of claimant(legal an'
I
Social Security number of claimant's spouse(last the digits) Drivels license/Identification/Other number Issuing State
of claimants spouse(last five digits)
CONTRACT RECORDED
tl buying on contract Fee Simple owner's name -
Recorder's office where contract is recorded Record number Page
- PROPERTY DESCRIPTION
Court A r Township Taxing dstri. - r.) _ Q 71“:4-1a1212.
Barrel number Legal description Is the
Property in question: /
a�:.__L fa -oo a3 9--co I property �yAnnually: ,. .•bile home(IC 5-1.1-7)
® If any portion of the residential structure or the land not exceeding one(1)acre that immediately sunoun•'�.t structure is used to produce Income,desanbe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County n Township
I hereby certify the above statements are true,correct and complete. `S et91 dal t jr_, ��(�_ 60(—a, •
Address(number and 4:t,-`sa ' r...=/ 7 3 I /7�, JU/ fp /-/F,/�I`/'r`i•-1 S
•A
ASSESSOR USE ONLY TRUE TAX VALUE SESSED V HOMESTEAD NON-RESIDENTIAL
AT S 100%OF TALUE TV VALUE VALUE
Land not exceeding 1(one)acre Immediately (I) .`�,j" vs,. r .. -j!:`-.y> `?
surrounding residential improvements. O � -s.- m.. ;:- . af'£z.'- 'a,
Other land (2) y.:-.1,:a Q7::
Total land(line 1 plus line 2) (3)
Dwelling W1.0rq '' ` s,ar
Residential Improvements or Annually 9 (4) -`�"' yr�Xo�.,
Assessed Mobile I Manufactured Home Garage (5) ��ig21,x'4 l;- y,`Ji.
-i-h 7" �-._ ms's.
Other improvements (6) "�yt -i -.yy><.
Total improvements(line 4 through line 6) (7)
Total value (line 3 pis line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor \l \\ Date signed(month,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 sun of the deductions provided in IC 6-1.1-12 to a mobile home that is $
not•.: <:.as real property or toe manufactured home that is not assessed as real properly may not exceed
one-half 1 of the assessed value of a mobile home or manufactured home.
Sig . Date signed( dr day---k.