Mobile Home_Knight CLAIM FOR HOMESTEAD •
f S EAD PROPERTY TAX YEAR
? STANDARD /SUPPLEMENTAL DEDUCTION FORM
State Form 6473(R12/609)
•
, ;- V. Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
CERTIFICATION STATEMENT
IP r
I(We) - AL / - /t _ certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following f .'bed real properly for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ I(We)own ❑ Am(are)buying under recorded contract
p 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 f daimant(kga/ ame)
Social Security mber of dolma s spouse(last five digits) Identification I Other number Issuing State
of claimant's spouse(last five digits)
CONTRACT RECORDED .
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(d ,town,township)
Parcel number Legal description Is the property in question:
r 1414,49 ❑Real property Annual assessed mobile home(IC 6-1.1-7)
f any portion of the residential structure or the land not exceeding one(1)acre that i ediately surrounds that structure is used to produce income,describe the use and portion
® N the property utilized to produce income.
J
-alp— Lto'? -ooios -00 -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County • Township
I hereby certify the above statements are true,correct and complete. ignatu�re lof edeant e
Addreesss Oyler and street,dry,state,and ZIP code) Si✓`�!` ♦ .4C Sr ere !oO
/� ASSESSOR USE ONLY TRUE TAX VALUE I ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL
I AT 100%OF TTV I HOVALUE VALUE
Land not exceeding 1(one)acre immediately `aT:,f + ,r g
surrounding esidential improvements. (1) . ,
Other land (2) fa ; '•'-tee. .
Total land(line 1 plus line 2) (3)
t1 • °
Dwelling (4) :-¢x%-'' •xc+2wfd:;-aK
Residential Improvements or Annually • u
Assessed Mobile/Manufactured Home ° _`te f ci 'Gara e
Other Improvements (6) , " ..t.
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 Data signed(month,day,year)
and complete. ys / /1
Verifying action-Signature of Author \I r h . lb \( \\Y) (\ I I Date signed(month,day,year)•SI STTAANDARD DEDUCTION ALLOWANCE
�VV-
20 pay 20 Lesser of 60%of the acvnsed 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 real property may not exceed
one-half(1/2)of the assessed value of the mobile home or manufactured home.
S' nature of /f
74--1- Date signed(month,day-year) .
