Mobile Home_Cox CLAIM FORRD HOMESTEAD ALPROPERTYDEDUCTION
TAX I YEAR
STANDARD/SUPPLEMENTAL DUC FORM �l^
Slab Form Fo 5473(R17/1-16) HC 10 (�If
Prescnbed by tie Department of Local Go eminent Fiance
INSTRUCTIONS:See reverse side for tying instructions.
NOTE:Telephone Social Security,diners license,state idenbficadon and federal idencfcaton numbers are mn.Sdental under IC 61.1-12-37.
. CERTIFICATION STATEMENT , .
I(We) James A Cox certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
I71 Own. 0 Am(are)buying under recorded contract. .
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
AUG 2 6 2019
Recorders office where contract is recorded Record number Page
• •/
et a �mmaa.
PROPERTY DESCSTPMGf2•±. .- ..st '
County Township • • h•• .is 7. or?.MOM eownship)
Gibson Barton Barton
Parcel number wtt
� I� Legal desatn Is the properly a Weston: �/
&ID-tab I-I/�t I[ I 0 Real popery ,t AnnuaN assessed mobele home(IC 6-1.t-])
If any pCfl=of the resdent al structure or the land not exceeding one(I)acre Nat immediately suntunds that structure is used to Produce income.denote she use and pardon
of the property uttized to produce income.
' . ,.r- 1'' . - PROPERTY OWNED ELSEWHEREBY CLAIMANT,. .^Q . .. ,
State.county,and Township Is claimant vacating a homestead?
0 Yes ® No
Signature of cb • /�
I hereby certify the above statements are we,correct,and complete. � 1/`/L/-/�`y]/(,�.
CDAddres63 s of contact(number and Tip rat: and ZIP code) Address of vacated homestead,I any(number are=eel,Cay,date,and ZIP code)
S ' SO
ASSESSOR USE ONLY'-e' I ASSESSED VALUE _ I HOMESTEAD VALUE " I NON-RESIDENTIAL
VALUE
(26(N1s Land not exceeding one(1)acre immediately (t)
surrounding residential improvements
Other land (2) - -
(i SO C Total land(line I plus line 2) (3)
_l Residential Improvements or Dwelling (4) •_ •
Asks annually assessed mobile/ -
Q(��CP�� manufactured home Garage (5)
Other improvements (6) - '
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
I hereby certify the above is true,correct. Signature of Assessor Date signed(month,day par)
and complete.
Vadywg action-Signature of 0udaw Date signed(month,day,year)
- -- STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed vdue of the homestead or 545.000.
Nolmthsanding any other prevision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not assessed as real properly or to a manufactured home that is not assessed as real property may
not exceed one-half OM of the assessed v of the made home or ma ()lectured home
Sipuwrr 1 ibr 71 (s Date woad(month,d]y,year)
I ^ ` a J \\, to -I tor .
DR TI TRIBUON: Onginal-County Auditor.FaeStamped Copy-Taxpayer /vv\Q a CY\`([JI
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