Mobile Home_Payne +4. CLAIM FOR HOMESTEAD PROPERTY TAX YEArt 1
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STANDARD I SUPPLEMENTAL DEDUCTION A (� FORM
,.e° Sam Form 5473(R15/5-14) \,\ \yam HC10
Pnsmbed by the Deportment of Local Government Finance U
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,drivels license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
® I(We) certify that I(we)omr ied as my(our)principal
place of residence or am(are)buying the foll • g described real property under contract for which a Homest orry�x��•
Deduction is hereby claimed on the date this application is signed, (date of g at ). '(We
kOwn. ❑ Mn(are)buying under recorded contract
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. 11tt tpgdC
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified persoga(}ksidjn& LU 1U
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
LU U
_ -_ F 1 'asstaudivaNi;S INp.ORMA i514 '^s; _ - _:�'GM ,::: ::
Name of claimant(legal name). 4
Social Searcy number of claimants spouse(led fee dgas)I Driver's tense I Idemicabon/Oaer number Issuing Sate
of da'unania spouse Vas,Thee 59aa)
Art T`+3_'7? ` �' r�i.s-;..��'sr_'�-'CONTRACTj RECORD ED'-xu ti.T °cx--- '>= ?i T.-
It beg on contact Fee Simple ovmers name
Recorders oce wies annum is recorded • Record number Page
:c' —`? cog a.3°yr7 g=FS4'.'Y 3:r ;1 ::,,Z2?PROPERTY DESCRIPTION:.s-?=r-".'-.r'':' .2"°s- :'3ir...--.-�. _s`r':n
Way Township Tsmig dsbia(oTy,town,tamshp)
Parcel nwnbe Legal description Is the property in question
❑Real property ❑Annuay assessed male home VC 6-1.1-7)
V any p Iron of the resider-Aral=axe a the and not exceedbg one(t)ace that is:eda'sy wounds that sbaYixe is used to produce income.desaue the use and poi
of the properA that to produce bane.
9S-/o3 - ov
-
- PROPERTY OWNED ELSEWHERE BY CLAIMANT .
Sam,Coady,and Township Is claimant vacating a homestead?
. ' 0 Yes El No
of claimant
I hereby certify the above statements are true,correct,and complete.
i�� cu
Address dconaq(number and shoo(,cal:rate,end ZIP code) Ad fva red ho eany Or end city,ride.and ZIPcode)
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I A �J •z
ASSESSOR USE ONLY I -ASSESSED VALUE I- HOMESTEAD VALUE I NON-RESISIDENTIAL' .
Land not exceeding one(1)acre immediately (1) Eij ,(-
surrounding residential improvements r-t =_. u--
Other land (2) x,,.... ,- , =-'r-�`-t-
Tota1 land(line 1 plus line 2) (3) - —- — ——
Residential Improvements or Dwelling (4) t„l rT' -c-,C>
Annually Assessed Mobile l • _
Manufactured Home Garage (5)
Other Improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) I(B) f
1 hereby certify the above Is true,correct, Signature of Assessor Date signed(moan,day,Year) I
and complete. 1.
Vaytg scion-Signature of Asrdtor /� Date signed(nnah,day,year)
\1
•
=W 3L-:at'I .c Y s STANDARD DEDUCTION'ACCOWANCE _r+,f=3�wy--�� vfi- raeig.a—'''-.�
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
0.
AtMMhs'anding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not assessed as real properly or to a manufactured home that is not assessed as real property may
I. not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home. •
manatee of Audda Date signed(moo*day,year)
DISTRIBUTION:Original-Catty A:dor,FieSamped Copy-Taxpayer