Mobile Home _Coomer CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
i- `;` STANDARD/SUPPLEMENTAL DEDUCTION FORM
��7; State Fenn 5473(RITJI-16) HCIO
Presented by the Decatnaa at hod Govamnaa Rums
a
INSTRUCTIONS:See reverse side forIli g instructions.
NOTE Telephone,Social Security,drivels Ecense,state Identification and federal identScalion numbers are c wr66denlial under IC 6-1.1-12-37.
CERTIFICATION STATEMENT -
I(We) s-a a( certify that I(we)occupied as my(our)principal
place of residence a am(are)p e following described real property under contract for which a Homestead Property Tax Standard
—DDed/uuction is hereby claimed on the date this application is signed. (date of signature). I(we):
L2"Oan. ❑ Arn(are)buying under recorded contract Am(are) entitled to ooadpy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the bust a the right to oaarpy the property under the terms of a qualified personal residence bust
❑ Am(are)the shareholder, partner,or member of the entity that on the property.
CLAIMANTS INFom.IATION
dune cif dot ra(legal rare)
SowStony number at desads spume(tea en 4Egar) Dover's bees J teal flir Oar comber d dame's spume gad ate dud) trotsae
Recker*aNJapPrwd's space don ro then a social secutynmCaJ
e
aOa Oaf ataaaad,Fee Swill comers name
Reader's new.here cores"a emdmd FEnu 21 20ir Page
PROPERTY DESCRIPTION - . '_ - _ -
Comer T Teadso-n(cay,leery brule) - grnfl�r
r.\(NCe R a`C9gggpI CUuNTY AUD1TnR . -.
Partaf rar.IDa teprr drtoRam boo pmpatyle
❑Red RWa1y ❑ATamly aaessedmWae to ns(IC61.1-])
tram paron d be resibpial sTLVeathe lad not meeting de(I)acre tatCNneetely oonsids tin structure is used to ai se income,deWIDe ere tee zM radon
d to praaty tithed to poate ice.
6l.Q - � ace - (o IQq -op
. ' _
- - PROPERTY OWED ELSEWHERE BY CLAIMANT.State.Casey,and Township Is claimant vacating a homestead?
Yes UJt1r -
4514daimaniI hereby certify the above statements are true.correct.and complete.
Address dom sh
earr(numbere a eet city.side.and Wen \dmac at):sate,end code)
AL
- ASSESSOR USE ONLY -.- ..i s. ASSESSED VALUE - , '- HOMESTEAD VALUE -• hOt RyEALIUENTIAL <%.
Land not exceeding one(1)acre Immedlatay ->;
surrounding residential improvements (1) _. .._.
d
Other lard (2)
Total land(line 1 plus line 2) (3)
Rasidembl Improvements or Dwefing (4)
annually assessed mobile/
manufactured home Garage (5)
xv
Other improvements (6)
Total Improvements(tAe 4 through line 6) (7)
Total value(line 3 pha tine 7) (3)
I hereby certify the above Is true,correct Siyeua of Assessor Dab egad(nut' day,feel
and complete.
vetpie action-Signature d Audta Dam steal(naaM,c):Yea)
.: ' STANDARD DEDUCTION ALLOWANCE ` .. .' .._ . .
20_pay 20 Lesser of 60%of Ile assessed vane of the homestead a$45,000.
Ndwdhffirx og any otterprahis on,the stun of the deductions provided in IC 61.1-12 in a noble tome $
that is not assessed as real properly or to m.-.. :.home that is not assessed as real prope*may
not65xad one-her(1/2)of the.. mobile homes manufactured 'T (y)
•
CKIme1/nON:Qip'vd-Couayaudaa. .• •t,opy.Ta�sJv
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