Mobile Home_Herrin CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
"' `; STANDARD /SUPPLEMENTAL DEDUCTION F
1� 1M.ly State Forth 5473(R13/12-09) �(� 10 rit
Prescribed by the Department of Local Government Finance ' t -.
INSTRUCTIONS:See reverse side for filing instructions. JUL 1 1 i
k !''' ... r 2.:; "rT 2, txy..az'.gr.444 n.CERTIF:ICATION'STATEMENT`. "'„'...;f:e_.g. u rr _i.'i7r-Yr.',e4-"7i::''r''-'t$ -:Vi=i=
I(We) .a rt. e 5 C N e r r I n certify that I(we)occupied as r)principal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax&efairMfiltiOgclypkogi is a claimed
der contract on the date this application is filed, (date of filing). I(We): 1 Y AUDITOR
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 ,
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
vit -- e4r „Sr. 1S.,r p„a ,ir_,..,,F.ry%-;,.�"CLAIMANT 7S_INFORMATION. .,:,, ,,,;.o1.kE*-__t _ aW ,.u:3 3-Ti! :., }
Name of claimant(legal name) `
0.Qme5 \p-;06 N err1 l3
Social Stonily number of claimants spouse(last five digits) Driver's license/Identification/Other number Issuing State
of claimant's spouse(last five digits)
r t3�i€- .4 ' -:kits...--r . . -_}- *4:-t4-.. n'i4gii.WiddNTRACT RECORDED L +"Z'+. t- _::.1:a4.;7}.15 ,.t;,. *..a .-t;:-_.:f.f.
If buying on contract,Fee Simple owner's name
Recorders office where contract is recorded Record number Page
<S,'ik.:.34t; ',... cir.>_q.:.. .t,:,l:Y?u:1,'VZ4 ..a:`irtli,ROPERTY,DESCRIP.TION.tiC t it";;; $.-.7 ;r!0 .u..e"::€2x -Y' E ;t-4/4.-f:
County Township Taxing district(city,town,township) (7-�/O
itP,�1,,y�,�'nu r.`�111/� r!� AP Legal description Is the property in question: t-y
h V \/ J ❑Real property l�/AnnuaOy assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
' t V
+ Y.n tv rs »+ �2`-:a-r ti ..r PROPERTY OWNEO1BY CLAIMANT:IN OTHER COUNTIES s= Li e <h 13n. t.�.rr'.: 11�
-
County Township County Township
I hereby certify the above statements are true,correct and complete. Signatur o claimant
A4 .
,. __(number. ,street,city,state,and ZIP cod.) /c/ '
kr & C -
x lnq,-Ite _ �. reaetz _ T L- A,,ASESSEDVALUE( HOMESTEAD. 4.,s a;n-sN.Or,NzRESIDEN. TAEi,,, 4i.;:
,".,r . g A,S_SESSOR Uf..tN..1 L?r u t 4 'te; �T EaAX �AULEA1_ATI UO.o OF T.TU i •.VAUE t t ;4.t :eVALUE ,e.z; , -4:c._.
Land not exceeding 1(one)acre Immediately ` 7` _= . ' -_ $f
surrounding residential Improvements. (1) i Pte! i l. r-+ 4` ;"` S-'1
'
Other land (2) ..• _,4,^tt_.ca y,
Total land(line 1 plus line 2) (3)
Dwelling (4) "` hr'a'o- n y..
Residential Improvements or Annually
Assessed Mobile I Manufactured Home Garage (5) t -w,� g. "tc,:thr ;C: t'+,T,l,
Other improvements (6) r `'y3
Total improvements(line/through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above Is true,correct, Signature of Assessor Date signed(month,day,year)
and complete. l�, \,]�
Verifying action-Signature of Auditor `I t \I) \ \\\\� 1 I 1 I Date signed(month,day,year)
' 4;: k.: .i+r: 44.braV42:k4.11P,7'....'s' 5O SSSTANDARD.DED\UCTIOfaLLOWANCE !:ai- _5,`'>igiZy,k;'k.2?fi__M..rs4r..,;;r It 1V.::
• pay 20 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 properly or to a manufactured home that is not assessed as reel property may not exceed
one-half(12)of the assessed value of the mobile home or manufactured fame.
Signature of Auditor Date signed(month,day,year)