Mobile Home_Madison (2) •
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CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
11 STANDARD/ SUPPLEMENTAL DEDUCTION FORM
S'..'...?..` State Form 5473(R12/6-09) H. r I i
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� :'- Department Prescribed by the Department of Local Government Finance — i
INSTRUCTIONS:See reverse side for filing instructions.
AUG G 1 6 2011 .
/' ^^ '' , CERTIFICATION STATEMENT M
® I(We) --`w, ) ,/ j[�/m%/ . certify that I(we)occupied as my( uc 1iie'pal
place of residence or am(are)buying the follow' g described real pwocudncF' homestead Property Tax Stand G(BDediiC04r1i5,herehyk i Y,-i R
under contract on the date this application is filed, (date of filing): 3ON GUUN7Y
�I(We)own ❑ Am(are)buying under recorded contract
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
0 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 b
CONTRACT RECORDED
If buying on contract.Fee Simple owners name '
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County • -^ Township Taxing.isip'4,town,townsh'.) .
Pa um, /n/ J-.l ,'f Legal descii.••• / Is to property in question:
ter-O�,J�O" '• ��—`- s• - 0 Real property T✓I Annually assessed mobile home(IC 5-1.1-7)
If any.. of the ed to produce structure or the land not exceeding one 1)1,that„ surrounds that structure is usedTo[p)oduce income,describe the use and portion
of the property utbed to produce income. ge5- 41 91 Mr
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township . . . County Township
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I hereby certify the above statements are true,correct and complete. Signature of claimant
ud
`t Address(number and street,dty,state,and BP code)
ASSESSOR USE ONLY TRUE TAX VALUE I ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL
I AT 100%OF TTV VALUE I NON-RVALUE
Land not exceeding 1 (one)acre Immediately r7 f;`�' e;z-
surrounding residential improvements. (1) lZ-...'' r; ` '
Other land (2) \��s '\l r - jf \
Total land(line 1 plus line 2) (3) \\` \I`� ^` ) ^�/ 17 (\11
Residential Improvements or Annually Dwelling (4) I (� 1 U"^
Accec,ed Mobile I Manufactured Home Garage 5 � 1` \V �l reJ-' ikV kF>
Other Improvements (6) '?tritax: 14K1
Total Improvements(line 4 through line 6) (7) �1
Total value (line 3 p1w line 7) (0) f�\ C7y\ '
I hereby certify the above is true,correct, Signature of Assessor \i c) "\ Date signed(month,day,year)
and complete. fM /\ `' Irk \
Verifying action-Signature of Auduer \t A\� `�\ \\J `� \� Date signed(month,day,year)
® STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000 /1
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that is $ \t
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
one-half(1R)of the acv.csed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year) '