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Mobile Home_Willis fii' CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR
- ; STANDARD/SUPPLEMENTAL DEDUCTION FORM
.�(y, State Form 5473(R151S14) HOW
'• tom Prescribed by the Department of Taal Government Finance
INSTRUCTIONS:See reverse side for fang instructions.
NOTE:Telephone,Social Security,drivers license,sta-identification and federal identification numbers are confidential under IC 6-1.1-12-371i
.® I(We) l a. / is certify that l(we)occupied as my(our I n•,. 1�
place of resi•ence or am(are)buying the following described real property under contract for which a Homestead Property Tax Sta -
�Dedduction is hereby claimed on the date this application is signed, (date of signature).i,Y7,a9n/T=S`
D4 Own. ID Am(are)buying under recorded contract / 0�
/❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. ��++ ?op
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualifi2/445 ' ence trust .
O Am (are)the shareholder, partner, or member of the entity that owns the property. H C
.j"e
Social Seamty number of claimant's spouse(fast tree digls) Drivers license I Wen-Ow:ion I Other number Issuing State
of clacnant's spouse(lad five dgts)
• 1'L
tK' ,3sa.°:0)4 °Fflti`5 --.:'^' ':^NCO__ .'Gil:RECORDED} �{'.;ILI EraVgft4.>`a;�.arr`H. �?-4^.g'sas�
If buying on contact Fee Simple owns name
Recorder's sea where contact is recorded - Record number Page
rrr-.Fs' _ -` 'Wt.ta. —_e,c`;a".>."""o= „PROPERTYDESCRIPT:CN ;.,7fitai "..-S yfr tilts-';ter
.'sLicit �'-iet`SC�-.'�I
Township
T.:, .. (clylvoxsxtown52y)
Partnd r,umiter n Legal desolation Is the grope y in guesbon:�{/'
// �'y_D5/Q7 /O 0 Real property (1 Amualh assessed mode home(IC 61.1-7)
�tl anyy9porton of the OOr es-Kal stistre or he land not exceeding one(1)ace that immediately surrounds that Y.rud:ae is used to produce income,deswbe the use and portico
soof the property utilized to Produce hra:e.
_ - PROPERTYOWNEOELSEWHERE BY CLAIMANT
Sate,Corny.and Townatip Is claimant vacating a homestead?
. . ❑ Yes ❑ No
Signature of claimant
I hereeTbby certify the above statements are true,correct,and complete. x A ^ ^ cal q 1 . ) \ //b
Address ixszi
V A,and to Zab 21P Add esss off vacated omesteaeX ,f any number lendN�eet,o'1:"statee,andzwwda)
ASSESSOR USE ONLY • - . I' ASSESSED VALUE •I HOMESTEAD VALUE I, ` NON-RESIDENTIAL '
Land not exceeding one(1)acts immediately -
surroundingresidentialImprovements (1)
Other land (2)Total land(line 1 plus line 2) (3) - -, . . _ —
Residential Improvements or Dwelling (4) )r "
Annually Assessed Mobile 1 'Si. _ - -
Manufactured Home Garage (5) •
Other improvements (6)
Total improvements(line 4 through line 6) (i)
Total value (line 3 pits line 7) (6)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,yeas)
and complete.
Vetting action-Signore of AULtec\/i f Date signed(men*day,yeas)
—? "<.jr_r 1-n^I'c etv Pa' ''s--STANDARODEDUCTION'ALLOWANCE._7 es; r= Ty -- "_."3`y17^- ',
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000
® Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 toe 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(112)of the assessed value of the mobile home or manufactured home. '
Signatre ofAudtor Dee signed(mot;day,year)
DISTRIBUTION:Original-Carey AUSSr,Fie-Ramped Copy-Taxpayer
