Mobile Home_Schmitt CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
FORM
Simi. STANDARD /SUPPLEMENTAL DEDUCTION HC10
t a State Form 5473(R13/12-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
S _ice . �(, y.f t _ _ d ,t i^yx ore p yt t` y. t-i—E
_��`�.�."i�•3':.++tYit.r.• /��? +?•c ~:'�a+._ -A�vr4w��."�CERTIF,I��AfION''STATEMENT .+�"y:�,a.. r �<N...77�7��-,+�fi+�.** 4d` , :_c •
I(We) �-/'_ A / certify that I r as�gtp��'p ( opal
place of residence or am(am) .4 . the following described real property for which a Homestead Property Tax Sta Bard XAed ction tS h>:re /;coed
(tier contract on the date this a•- cation is filed, (date of filing). I(We): ���LLLJJJ
u own ❑ Am(are)buying under recorded contract 0 C T 2 2012
❑ 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 rill denrl-trtls: ` '.
❑ Am (are)the shareholder,partner or member of the entity that owns the property. V
i nZf_=.l, i§t5t.t. z.a14z;?14:Z- i'r.'%isfi?rive tkre.'AIMANTSiINF,ORMATIONi.....4; .` a.-.:igil!ab4-4fia;'* :721 t ,Ith 3tT::,-..
Name of claimant(_•I )) /`� n
J�.t( V!
Social Security number of claimant's spouse(last five digits) Driver's license/Identification/Other number Issuing State
of claimants spouse(last five digits)
�.,l-i; x r vs :_4's;-- r .il: t att,riitfi4'-CONTRACT'.RECORDEDM` •.i.:;i . i 1'._.F.,:`tx'ely+1 ei;i •.s...:_•x r• r. .:.d1 s.ti..
If buying on contract.Fee Simple owners name
Recorder's office where contract is recorded Record number Page
'S-'-5'141;14 >ka. . s.-°•'ti*3_r...4`'+i:i,t ,1-Vtl a S..'..PROPER t.:OESCRIP.TION thl.a.X-Td:i ":vt...t.2.E= e4A;--t =_'xt ti_' l.-;5f
county As III/ Township Taxing district(city,town,townsh'
qp
p. ii, „,,ber . c Legal description Is me property in question:
��s y' ...OS COS 1 ❑Real property , Annually assessed mobile home(IC 6-1.1-7)
If any•z on of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to¢induce income,describe the use and portion
of the property utilized to produce Income. / q V
...$ t.'S,,,„,r .. w , ., : ..,,,,, _ 7r.PROP,ERTy OWNED;81'CLAIMANT(IN OTHEvecki T(ES.«Y`ttt f tai 1 A'..{^,'?_-,- s li'r&
County Township County Township
hereby certify the above statements are true,correct and complete. � "y81�n� 2 ��
(numbe street crty, ate and /P code) r /•`^/� -�`/L""rT/
/q / ZN S+r l r O4KL4 /4) c_/r7 /i/J0,
�,tr?u + ` ASSESOR+USE ONLY" 4 4, �STRUE TAX ALUEy_ASESSED VALUE:- `HOMESTEAD �9":'� NON RESIDENTIAL�.-t `�i+
.Atc• •. . .z s-,. L.-Y ;t i4 TR1JE TA _ _ ..AT:10010 OF TTV.) ..._E..iVALUE Sx --rtr+ -Sr VALUE •[ y I i
Land not exceeding I(one)acre immediately (t) g-xa '•'.=.. m s tIa ,
surrounding residential Improvements. -
'.
Other land (2) r,,,,e _ ,-_, '`
Total land(line 1 plus line 2) (3)
f.
Residential improvements or Annually Dwelling (4) ly-3*r a n -v laeta*x--
Assessed Mobile I Manufactured Home Garage (5) (3'-sit,ya3. +` r'i.•'^. :
Other Improvements (6) t� ak-*b
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. It \} `1 ty •/1�
Verifying action-Signature of Auditor 1h \1' 'J ,\ \t \+J \` 1� Date signed(month,day,yew)
-._ y N� .�
l'� +v i, 1�-.��'r? r,?��U:�� , .t�....�`,.�.ai.V.3r'STANDARD'DEL UCTION'ALLOWANCE: s..f.:�: ,:::r.�...,.'t..t*r1;;;....::.i•_ T_.Cz-..+:e °:t
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 61.1-12 toe 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 Bees ssaddd value of the mobile home or manufactured home. + .
��j1,,,71J 1�� Date signed(month,day,year)
.-IIY r /f
