Mobile Home_Madison tic-se CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
w jyypS?.a.,...,,,,: STANDARD/SUPPLEMENTAL DEDUCTION FOB \S.
[ill ivf Serb Form 5473(81711-15) HC10
Prescribed's:the De{me+mv of toad Government Finance
INSTRUCTIONS'See seise side for tang iutruda+s
NOTE Telephone,Soda(Security driver's frame,slats Idertefira5on and ldlk+alldu>lraffial mantes am onficS ffaltaderlC 6-1.I-12-37.
---..„ CERTIFICATION STATEMENT
- (• I(V4p) ♦lm7t a ft • a _ ^: certify that I(we)occupied as my(our)principal li
place of residence or am(are)buying the following desalbed real property under contract fa wAr&ft a Homestead Property Tax Standarg St...,4
Deduction is hereby claimed on the date this application is signed, (dale Of sgnab e). I(We): 4 -a
❑ Own, ❑ Nn(are)buying under recorded mrtracl 494% 1Q '-
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. Die eO�j
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal resid=1, - t.ei
13 Am(are)the shareholder, partner,or member of the entity that owns the property. 0� 4
/ .-
. CLAItdANT'S INFORt.1ATIOtJ - - - ` - - '� -
- -
Cantr Tmssakp Team dad(sy,Moat lcsrah p
Pawl ranter tea<in ate /9 x /p.J Its pa papery In question
s
a/77� / /�5/o LCI ` A^' syssetl male horn*(PC 61.1-7)
If any maim of es read:meai murexe a de tat roe enatixg are(1)on that hmueddrn snomdv that samase is used to produce hnane,describe to use and por+cn
d Me camera r a prase Mane
a/a /9s 00/ 7,5 -
;`;. . p,. :__r. ... ._._ - . -- _..,_ .�. __. -_. vgr:py .,r_-c
- _. -�'pROPERTYOVJNED ELSE3:WEREBY.CLAIMA?JT- - - - T-x^_ ° '3
Sate..Cane,and Tamar*, Is claimant vac:dim a homestead?
❑ Yes ❑ No
I Sgstra d
hereby certify the above statements are true,correct,and complete. Y ,{J//ee �/
Addmevdmdad(nredamlraeeL riry,sorre,and 2(07 rude) Adhm CVamletl d any(numbs r and ataR xdJ:Slab.and ZlPmde)
ASSESSOR USE ONLY: _ '.� . ' ASSESSED VALUE '--I .. HOMESTEAD VALUE- - -rm NO"-R SIIDENTIAL
Land not exceeding one(1)acre immediately 6r -yY4 - l
surrouncEmg residential vnprovements (1) ?�, a: 1 .::ti
Other land * r -s> r.
(2) ?;�,-..tee= �_ �?• .: :
Total land(line I plus line 2) (3)
Residenflal improvements or pwemng (4) -" ''
ta:
annually assessed mobile I x s _ -
manufactured home Wald (5) .Z.1-5 f'- .e '' M^
Other Improvements (6) , . .. h cd t
Total Improvements(fine•through line 6) CO
Total value(line 3 piss one 7) (a)
I hereby certify the above is true,correct Signature dasesso Date signed(maxq day.Yew)
and complete.
Verifying action-Siamese d4uda ( ^ Data signed(none/4 dig War)
-. ,. -. - ---÷"STALDARDDEDUCiIONALL04^fAiJC� ..---. ' �-"'mss
20_pay 20_ Lesser of 60%of the assessed ague of the homestead or$45.000.
/® NoMdhslance g any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mottle home S
that is not assessed as real property or to a nanufxbrnd home that is not assessed as teal property may
not exceed one-hat(Ii of lire assessed value of the mobile home or mamdacr cord home.
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DISTRIBUTION:Cug'vel-CaavyAUSa,R.SYmped Copy-Tayelr
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