Mobile Home_Hale ", CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
4 v STANDARD/SUPPLEMENTAL DEDUCTION
Sara Form 5473(R17/1-113) HC10
Presalaei by the Department M Lori Governer Frame
INSTRUCTIONS:See reverse side for Ong eutrllctons.
NOTE Telephone,S o d a/S e p a i t y driers S t a n z a slam l c l a d d r a S o n and f e d e r a l klentissafon m a r t e n a m.. .._....... >1.1-12-1. '.Ilk
CERTIFICATION STATEMENT
il /
1(We) e �l.11 e l I F / certify that l(.° •—1 X as my(our)principal
place of residence or- I are)buying the follo%Mlg described real property under contract for which a Homestead P t?�Mard
Deduction is hereby claimed on the date this application is signed, (date t
❑ OaIL ❑ 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 bust or the right to occupy the property under the terms of a guafifi trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. I
^ SON COUNTY AUDIT02
Parcel r . Legal disco=i Is the flety Ii quasdoit
❑Real ropaty ❑Annually assessed monde lax(C 61.1-7)
Nary portion si te reespntial saline cc ea lag not esmemg one(1)ere eat inmedteysumads tat amaze Is used to poeminsane,describe the use and portion
® at the progeny razed to poem irons
_7 12 7" - .- _Yge'.."-`...�:11'PROPERLy OwNEOELSEVHERE RYCLAIMANT '_ ` -'- sal. .r
Slate,Carty,ad Toaship Is claimant vacating a homestead?
❑ Yes ❑ No
Snare of daunt
I hereby certify the above statements are true,coned,and complete,
AdAm d--- -_(number end street cay sr,and Z/PmAr) 9 c.-ap andstnU,o y.sr.—ZIP code)
Att Set tom- lA32rtnif--S!C-t "; a
I.d U .ASSESSOR USE ONLY 1 ASSESSED VALUEm3'4 HOMESTEAD VALUE {-, NO_RESIDENrIAL
. . -4'VALUE
Land not exceeding one(1)acre Immediately , P {
^x
surrounding residemet improvements (1) .. - L='_^.fi
Other land (2) =.`.v: ...>._.t,7.;:il:
Total land(line 1 plus fine 2) (3)
Residential bapwemrmm or Dwelling (4) _t'.2s_ ;;_.'._ :.:_,;- -..z``, ;'
annually assessed mobile/
s *"i .t ` ^manufactred home Gage (5) a a ,
ntryYS r r '_Other improvements (5) _bra' ,;..4L . . =z:
Tat improvements(line 4 through line 6) (7) •
Total value (fine 3 pits tine 7) (9)
I hereby certify the above b t rue,correct, Sigiaue ofASayssar Day signed(nxutt say,year)
and complete-
Vdyitg fle-Sipwtte URndM
\1\\ O(\�I
Date signed(nwtn day.year) •
r_.s a. _-.e ... iii+ STANDARD,DEDUCTION ALLOWANCE +>tt.'T ; ,_ z.::' -,.,
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
® NoMtlhsfa dl g any aterprovision the sun of the deductions provided in IC 61.1-12 to a nnbae home $
(hett not use as teal popery or to av manufacmredhome gat is not assessed as seal popery may
not exceed V(IR)or the assessed mLaA tae home or n,enre/adrnd bane. `yam
wed •
1 — U oaa sig>011aa" my'L ��•
DISTRIBUTION:Origin-County Az .He-Stamped pad Crpy-Tellies (/((-
Page 1of2