Mobile Home_Rippetoe �- CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
i Ssm Form 5473(R17I 1-16) HC10
Presented by the Department a tecal Guerra Finance
INSTRUCTIONS:See inverse side for fang aubucbbns.
NOTE:Telephone,Social Seudty,diver's icense,state iden55;mn and federal idenlilicaffon numbers an contdentral under IC 6-1.1-12-37.
�7^`— CERTIFICATION STATEMENT - - \ \ \ d-
I(We) K C).Y� C1 v ,�Q e Y that I(we)Occupied as my(on)principal
1 , 1
place of residence (are)buying the fog described real property under contract for which a Homestead Property Tax Standard
"1
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): Qll�ll`�yy�Q
l / 0 Am(are)buying under recorded 1ded contra
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the test or the right to occupy the property under the terms of a qualified persona(residence trust.
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
Name of dermt(bgel none) a s
•
Soda Seaway camber of claimants spouse(last bee dies) Driver's kerne kientiSaation 105w number of danmvts spouse gas era ages)
05pfcaSe orgy✓extre.a's spasm des nor new a sal seas*=ear.
t batmen axrrac.Fee%Wile fls 1mm 4^ VV
282018
Reaee's ohm valuenaiad is recorded Raoad runts /7r Page
GI&S Nona 4a7
- - - PROPERTY DESCFIPTIO'1 -" - _ 1
Casey Township Teoinrder. (r>ty,ben bey*
`YSC � et 11L��� �1 �VOIToR
_Pr dra 7
ranitr� WSd...own Is the r in gantlets
.Rei irNaty ❑Arnny avessed mote.lone(IC
a any paten of to resYbrval stuare or to lad net sae:bp an(1)toe Sal inrtwdaety samass tat swsre is used to produce troome desdbe ate use as roman
d to properly t ed to praise Dome
a -Q-- a $ - oos‘a -07-
PROPERTYOWNEDELSEWHEREBYCLAIMANT
State,Cowry,as Toedep Is daimanlvacating a homestead?
❑ Yes ❑ No
I hereby certify the above statements are true,correct and complete. (r -
Address al canted(number
aae stl ray ee she.and ZIPcor) Address a mated hcri d)Carry(number end theet,cty sWe.end ZIPmds)
•
a es = . .'Cc *- nrc- I -.r wun
• ASSESSOR USE ONLY > _) ASSESSED VALUE • r.HOMESTEAD VALUE'.--� ti'NON R SIDENTIAL ;
Land not exceeding (1) �• "-_ e.-surrounding residential uapavemens Immediately .,+a
Other land (2)
Total land(line 1 plus line 2) (3)
Residential inprovemems or Dwelling (4)
annually assessed mobile l
manufactured home Garage (5)
Other improvements (6) •_..-, jGr_�sst. -^C ti
Total improvements(lam 4 through line 6) (7)
Toni value (line 3 pus line 7) (B)
I hereby certify the above is true,correct, Signore otAts a Date signed(rraan,my ywed
and complete.
Veifyvp action-Sia=re dames tea shoed(morale day yeed
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notnrhstarxing any other provision,the sun of the deductions patted in IC 6-1.1-12 to a moWe home $
that is not assessed es real property or to a manufactured borne that is not,nn<'<nd as teal property may
not exceed one-hat(12)of the asse valor of the mobile homer manufacturedhome.
• d Audior jin/N- SL-c
Do'ssWied( �y 1ean
1._ 1T 1 Cyr g-
OtSiWBUf0W Oeig'vvl-CaaayAud'.a,Fas3ariped Capyy-Te•Qaya
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