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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 Page I of 2