Mobile Home_Scott CLAIM FOR HOMESTEAD PROPERTY TAX
1,_ STANDARD/SUPPLEMENTAL DEDUCTION FORM YEAR
.1 Sate Form 5473(R15/5-14) HC10
- '• Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. . i ) ; ,\�
m NOTE:Telephone,Social Seay,driver's license,state identification and federal identification numbers are con,c,e tial; •e 1 C 6-1. 12-3 I
." - ` CERTIFICATION STATEMENT - -k -.- - - --- -• -- -
® I(We) Alt _ .'A A a / = / _- -•ify that I(w�f�p�P' i gi� r)principal
place of residence or am(are)buying the following described real •roper'I' •n a or which a Haarestea f pA:l�ji%x Standard
Deduction is hereby claimed on the date this application is signed, (date of Signature). I
(We):
• Own. 0 Am(are)buying under recorded contract. n/
❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. �'Ifju a
❑ Have a beneficial interest in the trust or the right to occupy the property under the term18 re9i' QR
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
_. _...CLAIMANT'S INFORMATION. rti- - - - _ ..
Name of dainal(legalname) ^ - -
_5-,a `')
- .. „-„_
If buying on contract,Fee Simple owners name
Reader's office where comract is recorded Ream number 1 Page
-_ism_: - __- _ _`__'.,y'.,6PROPERTY DESCRIPTION -1''ysjy � .�_-?=rs:- —c_ ,
Caucy Township n Taxing disrip(at''t m.tmmshry) '
Parcel number Legal desoipion ( IsIss/the`/prronoperty iinnygVu�on: .�.ef'��
alp— y/S�— CO Q93 —a) 0 Real property yArnually assessed moose home(IC 6-1.1-7)
If any portion of the residential sincere or the and not exceeding ore(1)acre that immediately surrounds that stm acre is used to produce income,(*saibe the use and portice
® al me property wised to produce nm.-a.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
'sate,Coua.ty,and Township Is claimant vacating a homestead?
0 Yes 0 No
Signature of-�-.ma••
I hereby certify the above statements are true,correct,and complete. / ' 9
-✓///
Address of contact(number and=.feet rty,.Cate,and ZIP...-) ' of vacat- h _,ead,'any num_'e cey.r end greet gaze,and ZIP code)
7` i i W / A . '-
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NONRESISIDENTIAL
VUE
Land not exceeding one(1)acre immediately I(1) I
surrounding residential Improvements
Other land I(2)
Total land(line I plus line 2) I(3)
Residential improvements or Dwelling I(4)
Annually Assessed Mobile I
Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (1) \ ,\
Total value (line 3 plus line 7) (8)
I hereby certify the above Is true,correct. Signature of Assessor Date signed(ngn:h,day,year)
and complete. (\��
Vai}r'9 d aaipn-6gnature of Actodor \� IS
Date signed(month,day,year)
1 ir• : •
` C —2 _ STANDARD DEDUCTIONALLOWANCEt yE,t1 v( :�a1 .:>
20 pay 20 Lesser of60%of the assessed value of the homestead or S45,000 t ��}
® Notwithstanding 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 property or to a manufactured home that is not assessed as real properly mayDECC
notexceed
exceedd one-half(1/2)of the assessed value mobile home or manufactured home. `y � U.(2O'4
Date signed(minim.day.Her)
awlm sTaoR:Ovine!-copmy AiE.br.Faes zp amped Copy GIBSON COUNT/ OR