Mobile Home_Tinsley f CLAIM FOR HOMESTEAD PROPERTY TAX
YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
t=" Sae Form S473Quill-16) HC10
W, Prescribed by an Meanest&land Goverment Finance
INSTRUCTIONS'See reverse skis kw limp instructions 1 ', t t '
NOTEI Teter Social Sauat%Oriaers fans°,state tdent�ra&ae arndfederal i enlifcaffm numbers are.-.-.......t• •- i 6-I1-1 3. 1,l
• CERTIFICATION STATEMENT . "'-'- '
® I(We) 4 I Al>d /a certify that I(we) as (° p9ndaal
Puce of residence cc am(are)Dining the following real property under contract far which a H�IIRaL'2.1 Pm�elty FaX$IaMard
Deduction is hereby calmed on the date this is signed, (date of signature). I(We):
❑ Ohm 0 Am(are)buying under rerbrded contract.
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooper:AMU housing corporation.
O Have a beneficial interest in the bust or the right to occupy the property under the terms of lteda{t''Es I O R
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
-, - - CLAIMANT'S INFORMATION - -. I. :,
Soon Swat),timber of deman s spine(last the ate) OmMs Somas/idaCfxalco l Over number of decants mane(last ems cast) Isvk,g Stabs
Wwfatie any aappEcara's sparse doss nor hese a soda)smutty nanbsr
iw - -^. a - .r _ 'r4`5+'' . _ n' CONTRACT:RECORDED rYt::,C_. _ :. i :4-is".. =n=s.J
If twig ah CMfa.Fee Simla avers rare
Recorder's efts ahem contract is recorded Reoxdnnber Pepe
. . . PROPERTY DESCRIPTION - (trr++jj • -
C ,
aaaY� , • ` Towed* T®v' 0$ l l i aI
a�
.-nsffier Legal dump`. , Is the property is
`✓- 1 `' r 6b7103-D9 ❑Rea pygmy assessed home 11C 61.1-0
N any paean of the redderael sincere or the land not ercree g ors(1)acre eatimmettly WruNs that wince is used d prorate aroma auate the use and pinion
® d en pr perty u rmM a prom nomvs
V
State.Canty.and Township Is claimant vacating a homestead?
❑ Yes El No
Sidman of claimant
I hereby certify the above statements are true,correct,and complete.
Affiess it oaten(rembe-asd stem cite.date and ZIPm4) et (reinter . and ZIP rode)
1 N `9 -Ai f1)(� A./ 5 Off Ku 4 H✓c 'ry
•
NON-RESIDENTIAL
y. ,,ASSESSOR USE ONLY _ . b- ASSESSED VALi �lHOMESTEAD V_A WEY , VALUEY� '
Land not tely
salam?mg residential onebnp owmam°I)acre la T (1) '� 4Y 'na. ::-s
Total land Giro f phi line 2) (3)
Residential improvements or Gelling (4) `:.r-r-_ Stub.=*.u--:ts—._..
annually assessed mobile I v
manufactured home Garage (5)
Other improvements (6) l^Mind
Total improvements(firma through line 6) (T)
Total value (line 3 pis line 7) (0)
I hereby certify the above is titre,correct, Slaelse SM•.sl.v Dan signed(m t day,ten)
and complete.
Voting anion-Synabre of Author kill
4 Dan sided fuss*day.year)
>Cs5 .^` -•� ��".i..'- :� .a ` s:_ - `STANDARD•DEDUCTIONALLOVIANCEiiw `� ' "*
20 pay 20® Lesser of 60%of the assessed value of the homestead or 245.000.
any•
Other provision,the sum of me dedxaons provided in IC 61.1-12 to a mobile home $
Nat is not seed as real properly or to a nian�ufaadwed hone that is not assessed as real properly may
rut exceed (1/2)°/the essessM" ` mobile ormamd2etramd none.
.t Date (ntrtli d aY.� :
'
DSTi®I1110N:odes-CavayAulror.Lie-Striped Copy-Taxpayer atifi
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