Mobile Home_Thompson ., r CLAIM FOR HOMESTEAD PROPERTY TAX , i,
�-`'�` STANDARD! SUPPLEMENTAL DEDUCTION
I
:,:j. `� " State Form 5473(R13/12-09) r
--am Piwsmbed by the Department of Local Government Finance r 9 r Q 20 1
INSTRUCTIONS:See reverse side for filing instructions, Lk
ria /.:�1.ik.,i:.-d'e.A1. - ✓tkl. . `w4-it .iilAn •Ss; CERTIFICATION;STATEMENTETx: ; ? 'i.s•^ :%rt-_(1,k;i si i" `+`. _-it•:e t gi_Zi -.�-_r: e..
I(We) ��/L�LLs�fl'.l4 ./ A : certify that%ltS�B 1RY1 J .a,.:pal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby daimed
(er contract on the date this application is filed, (date of filing). I(We):
Own ElAm(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
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
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fir,-' '}:'-_3 .vMA:s'4'4., ..::a,serijei'i'?;iac",jj:.nro~"':*" CLrAIMANTS INFORMATION,sli,?;`iti:.1.:`t>- .x'bwNI.'".4i '_�.' a.�f�' $z:-.. '-esi
Name of claimant(legal name)
Name of claimant's spouse(legal name)
Social Security number of claimants spouse(last five digits) Drivers license I Identification/Other number Issuing State
of claimant's spouse(last five digits)
�+.i's t 71c- y:r -a aY+ggi€..,..:.irn .r li I t t` ` _::g''leM::1413,V5,i t,. i."JOI.ff' it ems'.
L'��E`+ .-r:,m.�•;:,- .4�4.;-A-'s.aF-x+`ar�"-�t_2�CONTRACT;REGORDED #v?.�
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
Khk'`S„:147yai ix u iaY+'¢_ b-ill '. i ehfiFERTYIJESCRIP.TION,n:2 11 xzafi -i*;51.V.A,..a; '.0 11F11:tikt4'"c
County re/
Township Taxing (city,town,township) .
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Pa numy O^-' Legal description /tss thhee`pro=erperty in ques
�— S—6 s3-C�° /920 J ❑Real property Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure S to p Me income,describe the use and portion
of the property utilized to produce income.
110
3faatVi y?j'ja. a,Agikcci-O : aP,R6 ERT;Y_OWNEDBYCL`AIMANT,IN,OTHERtCOUNTIESS?+�t` .# **Or: W4!`_.°„:::‘Wimti-f.m't
County Township County Township
I hereby certify the above statements are true,correct and complete. Sig of daumant
-2(Ubtmla) O n
Address(number and street,(sty,state,and ZIP code) - . -
LIo . 0 uMFle.(-D Flue tQ� y f rInce-i -k N q-k67o
'[r r:+ sue S StiS Sa n- EE a :iti}- n i irsRUin A •VCAU Ef A E HOMESA 5 � ' :•x-COisi:RIONTA + 'r L
r ZS 3 y2ASEORUS .ONLtrF„iwAL ET AT100E OFTTV ..? E i 3 ALE _-
Land not exceeding 1(one)acre Immediately ' r 1-c' y � {3. `"g:
surrounding residential improvements. (1) ' ':'' •^.`? "si f
Other land (2) - n 271 mr;4»h.=
Total land(line 1 plus line 2) (3)
Dwelling (4) ox ,F :8,.e-tit' r cKt,
Residential Improvements or Annually -z ,
Assessed Mobile/Manufactured Home ,-F: pT.e. ,, x ,„_;
Garage (5) a1:-,._ ... -..;:-s�.* .-.: :xfi i
Other improvements ( ) '+ 1, _''`C y_Iv:.
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above Is true,correct, l� Sigce re of Assessor \_ I � Data signed(month,day,year)
and complete. Ay
Verifying action-Signature of Auditor ` \ \ \ ', Date signed(month,day,year)
,:7,5 t i.:± 5itgA4:1;.:01,`.a2' . it.tSphc.,'.kr TAN,aARDDEDUCTI6"1-LOWANCL4 ^.a•,0.:.:1 c a z..x_ui _--Wf..:tr. 3:4-i_'t :x?S s
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
M,twit tstandl g 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.
Date signed(month,day,yea,)
Signature of Auditor ...