Mobile Home_Penner " .CLAIM SUPPLEMENTAL ? it YEAR
� STANDARD / EDUCT N d-
S .'• c. State Form 5473(R12/609) HC10
,•� Prescribed byte Department of Local Government Finance v A : • f 3
INSTRUCTIONS:See reverse side for filing instructions. j
.i
. .dr._.��/!call.
CERTIFICATIOIJ STATEMENT
® I /.
(We) / certify that I(we)occupied as my(our)principal
place of residence or am are)buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the da e this application is filed, (date of filing):
❑ I(We)awn ❑ Am(are)buying under recorded contract
❑ 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 of i(legal name)
•
Social Security number of daimanrs spouse(last five digns) Driver's license/Identification I Other number Issuing State
of claimants 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(city,town,township)
Parcel number egal description 64n2 P(4 Is the •,,erty in question: /
I a0-Z-ii\/ l!n. / ❑Real property . Annually assessed mobile home(IC 61.1-7)
® Ifa/�y portion of the residential structure or,e land not exce i g one(1)acre that hrvii4iately surrounds that suucL.m is used to P uce income,desmbe Oro use and portion
of%a property utb¢ed to produce income. •O d.s- o 031s-00
a� Ya/ 90089 -0o a
a(o-/!- . • - 300 - 7a `/. / 7 (0-0 X/ .
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County ' I Township
I hereby certify the above statements are true,correct and complete. Si Lure of claimant •
. X r/91,24
Address(number and street,city,state,and ZIP code)
a 5 w • •.ti s . 7d
!ASSESSED VALUE HOMESTEAD I NON-RESIDENTIAL
ASSESSOR USE ONLY TRUE TAX VALUE
I AT 100%OFT V VALUE VALUE
Land not exceeding 1(one)acre Immediately `x ' 'w - 0
surrounding residential improvements. (1) > sxsz 1 4Jc• -� h
Other land /L (2) / r��J tv?` f�,'a .i.
Total land(line 1 plus line 2) (3) s\)(\k`a I` p
Residential Improvements or Annually
Dwei rig (4) \ I :c� iS`°sk ' "Sf'� y 7_tis .'fiv,„
Assessed Mobile I Manufactured Home ?4 tom ��2 n"` t
(5) Ik Y(' aitAA-trka dt• a
Other Improvements (6) • isit "yys .
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 Date signed(month,day,year)
and complete.
Vol • •action-SignaW{e of Auditor Date signed(month,day,year)
• 4 r .4 4 0 • . .
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed 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 property or to a manufactured home that is not assessed as real property may not exceed
one-half(12)of the assessed value of the mobile home or manufactured home.
Sig tuna of Auditor • Date signed(month,day,year)