Mobile Home_Mancera CLAIM FOR HOMESTEAD PROPERTY TAX FORM a STANDARDISUPPLEMENTALDEDUCTION
State Form 5473(R15I 5-14) HC70 Gil
Prescribed by the Department of Fatal Government Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE:Telephone,Social Secumy,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-3
�__ -.CERTIFICATION STATEMENT,P z.-4 a x•_'14 'u .. Y- -;Y:Y-
®. I(We) , .,„w! - -f�-�"� 4tertliy that I(we)o I s (ou •.
place o residence or am are •uying the following described real property under contract for which a Horn i.teed ro rty T i• \ ..
Deduction is hereby claimed on the date this application is signed, (date of s' t �;
❑ Own. ❑ Mn(are)buying under recorded contact A,A
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 1y/ R g ''nn
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence st .
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. '
'.-} - -- 1, 'F-Si A_ sf:�i .ti—11/(1 ANP,S INFOR6UITIFIN-4.»':3 �/' 1 fps R27�;�.7a7 ,/.�..::b
Name of dzinant Uega/name) y�/f
Soda/Seo:rcy number of claimant's spouse(last five dgt,) Driver's Gru-se I Iders ration I Other number issuing State -
of claimant's spouse(last five digts)
E_?_ .u•S -ij i:11,`arzt.,t;72.4' t " -CONTRACT/RECORDED.2 5'-IaSR9lsX2 'S:P- Civet
If buying on contest Fee Simple owner's name
Recordees o8ce where cra C S recorded • Record number I Page
gl 'as1✓r_`b,` ; ";`S4-1 `2ONFROPERTY-DESCRIPTION- :,'s(wy _� ..: :_a"rn���`�
Cony Township Taxing� lobed
I Panel number legal description [n Is the property in questoa
T/
1979 ❑Real property (% snuaIy assessed mob4e borne(IC 6-1.1-n
If any portion of the residential stix]ae or the WW not exceedng an(1)acre that i t-ed'a'ey au^amds that re is tsed to produce income,descibe the use and porn
0 of the property streets to produce income. �// a 9 �1 xn /r
.(�- (IIDYY /PROPERTYOWNED ELSEWHEREBY.CLAIMANT it . _ L.-'17. 'y' E
S ts.Carty,and Tenho Is claimant vacating a homestead?
❑ Yes ❑ No
eignature of aliment nn
I hereby certify the abovveye statements 1are
ytrrure,,,-correct,and cocomplete.
' 11'j C Ia i 1 1 a r/ DA.V,
esO SRmb and
"r �A�W1 1 ) I�l �J'U11�.Y1�sof /� any(number and Srtet rey.gale,and ZIP code)
. ASSESSOR USE ONLY s I • ASSESSED VALUE , " HOMESTEAD VALUE' "J ' ;NON-RESIDENTIALr
, VALUE .-
Land not exceeding one(1)acre Immediately ,(-J; ,: r `T'°' `^
surrounding residential Improvements I(t) ........__.a-..wiI te.'1)`_-
Other land I(2) .%�:4n'j.'... ''.i=3: :1;11
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (a)
Annually Assessed Mobile) _ .; ,
Manufactured Home Garage O t^ -i
9 I(5) .at i `:>_ ,6;.:..
F-..
Other Improvements I(6)
Total Improvements(line 4 through line 6) I(7)
Total value (line 3 phs line 7) 1(8)
I hereby certify the above Is true,correct, I Signature of Assessor Date signed(ninth day.War)
and complete. a' Q .
Vedyiy action-Signature d AUdta \' 1 V Date signed(math,day.yeah
(si[�- "`-'--'--' _-` STANDARD DEOUOTIONALLOYVANGE�Ta^`�-`T—a -!6ragi Y
® 20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000 tI
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe mobile home 5 1
that is not assessed as real property or t a manufactured hone that is not assessed as real property may .
not exceed one-half(112)of the assessed value o f the mobile home or manufactured home.
Sip;a^y Auditor e o /,- Date signed(movtl day,Yea
DISTRIBUTION:Original Cary AUddor Fie-Stamped