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Mobile Home_Walker
CLAIM FOR HOMESTEAD PROPERTY TAX YEAR STANDARD I SUPPLEMENTAL DEDUCTION FORM ' OR x •' Slate Form the 15/5-14) Prescribed by the Department of Local Government Finance INSTRUCTIONS:See reverse side for fling instructions. NOTE Telepho > Social Sewrrry,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37. / - - /bERTIFICATION STATEMENT'-. i - ", - ` ?.: c • '*� I(We) S. __1_. QJ 'ralraff/ll certify that I(we)occupied as my(o ndpal place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax ^ojery� Deduction is hereby claimed on the date this application is signed, (date o signature). (We): ` b' ❑ Own. ❑ Am(are)buying under recorded contract. Was 1." Os 0 • ❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. HCnn �! ❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal resra-- ri/'t_4•,- ❑ Am (are)the shareholder, partner, or member of the entity that owns the property. q r. , ' "* - - - CLAIMANCS INFORMATION', ." �.._:.• i.F- i y. Social Sevrnty number of claimant's spouse(last five dgts) Driver's acense/Identification/Other number Issuing Sate of claimant's spouse(last five dgas) _-i"- r - - .-_ 's'..i CONIRACTj RECORDED *- . .i. _ v. KrF- _3'�='. r If b y ng on contractFee Simple owners name Recorders o:.ce stare contract is reco.ded • Record number Page - -_tom=QC--_ %.,_ -3 c -.i..:PROPERTY.DESCRIP.TIIIN 'i..: -i_✓=4+ 'ris?:-r- :b- ` '-z Lau+' Township T- ' •duty.town,tmmala Parcel number Legalga description Is me cry in question: { /'d (c /ES I el property �l/f Annually assessed mottle tome(IC 61.1-7) 410 If porace of the residereial spume or the land not esceedig one(1)we that immediately surrounds that soucure is Lied(o produce income,desci a the use and po.`tat itepent' income... !'.{ /, 49)46 .4- a-ceit r S-oo PROPERTY OWNED ELSEWHERE BY CLAMANT Sat.coney,and Township Is claimant vacating a homestead? D Yes 0 No Signature of clamant I hereby certify the above statements are true,correct,and complete. / 'diIA,0--"der_ IVQ. Address of contact(number end Sreet.My,stele,end ZIPcode) Address of vacated homestead.i any(number,end street.ody Sate,end ZIP code) /fll//I`,.(/` g 5 v o IAJac h C / ' . 10-/ E 9 Pr•, el 0,-) R y .70 Land not exceeding one(1)acre Immediately (t) surrounding residential improvements Other land (2) Total land(line 1 plus line 2) I(3) I I Residential improvements or Dwelling (4) Annually Assessed Mobile/ Manufactured Home Garage (5) Other improvements (6) 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 P•vsm I Date signed(math,dey year) and complete. Vetyi'g actin-Signature of Pudiler Date signed(moan day,year) --"` -eifi.rI '^=7V STANDARD DEDUCTIONALLOWANCE/T -^E - a @i; © 0 20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000 NolniMstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S Nat is not assessed as real property or foe manufactured home that is not as•'nssed as real property may nor exceed one-half(1/2)of the assessed value of e mobile home or manufactured home. Signature of Auditor \I) 1`/) 1{(� Date signed ( dh,day,yea) aey DISTRIBUTION: Original-ee AucLt 4FiaSamp d Taxpayer\I`Y '