Mobile Home_Fritchley CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
s- ; STANDARD I SUPPLEMENTAL DEDUCTION FORM
_ State Form 5473(R15/5-14) HC10
„. Prescribed by the Department of Local Government Finance I 1
INSTRUCTIONS:See reverse side for Ong instructions.
NOTE:Telephone,Soda/Seadly,drivels license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
�- `�-s �� � � .-CERTIFICATION STATEMENT - -- _ - _ = -
, I a "1 ,. ..
®
I(We) ��,r.[/(Kl.T_i I L-Sr I 4 certify that I(we j--• P • - my(o I, •tin. .. i
place of residence or am(are)buying the following described•�I property under contract for which a Ho A estea Pr-,.e . : -n L •
Deduction is hereby claimed on the date this application is s: ed, (date of signature). "e:
❑ Own. ❑ Pin(are)buying under recorded contract APR 15 2015
❑ Arn (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
O Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property. •
Name�of/C�=Lnant(legal name) e
Social Security number of claimant's spouse(lass five digits) Other's license/Identification/Other number I Issuing Save
of daimant's spouse Gas/five dgts)
-..� ° 4.-=,:. .. ri:-.� `d.nrtr .CONTRACT RECORDED '7".., r`-' -`y'- .s--.'i'.1- f" _
If burying on contract,Fee Simple owners name -� - -
Recorders office where conraw is recorded Record number Page
-- :shr _-a.. _
ter" i-�._,..a -- _
'. F--� - .� z.:.-�ri-�`• PROPERTYDESCRIPTION �.::%�:._, z`�.4:�:�-�cY3* racixS74F:
County Township Taxing district(qty,town,township)
Parcel number Legal desonpbon Is the property in duestion:
• 1197 ❑Real property X.Annua%assessed Mrade borne(IC 6-1.1-7)
If any paten of the residemal structure or the lard not ex vg one(1)awe that .mediatey surrounds that stumure is used to produce income,describe the use and portion
of the property- co
abed to produce inme.
to
aG- Ypa- os o39-00
PROPERTY OWNED ELSEWHERE BY CLAIMANT I
Sot,County,and Township I5 claimant vacating a homestead?
❑ Yes ❑ No le
I gn of claimant I
I hereby certify the above statements are true,correct,and complete. n/�/a/qJ� may/
I res✓l/`'C�
Address of coma Coombe.and greet,qty stet¢,end ZIP code) Address of vacated turt,ez'
a umber� � end ZI )�,/ // 62 . T i r av . • r I Lsv
G,S
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvement
Other land (2) I
Total land(line I plus line 2) (3) I
Residential improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) -
Other improvements (6)
Total Improvement(line 4 through line 6) (7)
Total value (line 3 pits line 7) (6) I
I hereby certify the above is true,correct, Signature of Assessor I Date signed(month,day,year)
and complete. //(��� !
Vetying acion-Signature of AM.tor \� 1 1 Date sunned(month,day.year)
< �"" ? a�:i;t7Z ,-_tact -_•"-It:STANDARD DEDUCTION ALLOWANCE''-:' Wan.r;"F'
_ 20 pay 20 Lesser of 60%of the assessed value of the homestead or$45.000
® Notvathstanding any other provision,the sum of the deductions provided in/C 6-1.1-12 toe 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.
Sgra:u!dPnd.ta , ` Date signed(nveh,day,year)
DISTRIBUTION: Ongial-CouryAudcor,Ede-tamped Copy-Taxayer