Mobile Home_Stephenson z"'" CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
1 STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R13/12-0g) HC1 O
,��� l Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
' r's, /i a -. = -- _CERTIFICATION STATEMENT - -
/
I(We) s� '-/c 4r _ al2, - certify Y= I(..'- ._ ..i-' - d" ...')principal
place of residence or am(are)buying the followil{g described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing). I(We): SEP 1 9 2014
itOwn ❑ 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 qualifieGMISER41 UDITOR
D Am (are)the shareholder, partner or member of the entity that owns the property.
r _ _ _- T-:.>, it z i:.:4 T-codmA—NTFBrNFORMATION,Y.:Y':s: ' ems" , as .- St . .-
Name ai ant(legalname) . /
iL� rir f/c /
Social Security number of claimant's spouse(last five digits) Driver's license/Identification/Other number Issuing State
of claimant's spouse(last five digits)
- . - - \W . 2 _ ii;x..w .- 2 17"CONTRACTyRECORDED- 4'rc 1- + y` _
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
c_ _ "'cat? _ '*PR.O PiR TYDESCRIPTION- • , _': '�a;� _ _
h
County Township (Tayaq dyyvict(city, ,township
Parce)numbe , Legal description C�J/GIs the property in question
LINO— n1�o - DS-471 -'ci - J? /3 I (��CII Real property Annually accwssed nwbae home(IC 6-I.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surroun s that structure is use too produce income.describe the use and portion
of the property utilized to produce income.
.` 4_ ! IX - /cl- 7 jod- Oo/- O,1r9-- Oo76
zPROPERTY:OWNED,BYCLAIMANT IN OTHER COUNTIESr - m _ ' -';
County 1 Township County Signet Township
I hereby certify the above statements are true,correct and complete. Signat r f claimant I ---\K S._-�_`.`�'Cr1 e0/9
Address(number and street,city,state,and ZIP code) �.
atc— .v�' '— -M _
ASSESSOR.USE ONLY .' t:TRUE TAXr VALUE ASSESSED.VALUE I HOMESTEAD_ NON-RESIDENTIAL
_' .. ir ':zw.__� .ax.s..-v:,:KAT 100%,0E1T�TVti r=zv:VALUE . ._VALUE.':=
Land not exceeding 1(one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential Improvements or Annually Dwelling (4)
Assessed Mobile I Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
Ihereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor S R Date signed(month,day,year)
_,:_ _ <-.--FrSTANDARift DEDUCTION ALLOWANCE - _ _ -e
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(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)
4