Mobile Home_Antle CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
- �;� STANDARD/SUPPLEMENTAL DEDUCTIONFORA! t^
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„: State Form 5473(R17/1-16)
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Prescribed by the Depailmentaf Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state idenfilsation and federalidentficaffon numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
III IL
I(We) a -A e., 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):
Own. ❑ 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.
SEP132019
RecorcW's office where contract is recorded Record number Page
-PROPERTY )ESCH'r T ii)l �m
County Towns � lGIBSO T-'. . '-;1 T t`AT7 VR
1 r"
Parcel num per Legal description la the property in question:
\e.... CI property Anrmaltyassessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre friar immediately surrounds that structure is uce income,describe the use and portion
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\�\ of the property utilized to produce income, - u- 9$ - d -133 -00
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead'?
❑ Yes ❑No '
Signature o aimant
I hereby certify the above statements are true,correct,and complete. )c"Address of contact(numberandsheet city,state,andZIPcode) homestead mberand street,city, -- and ZIP code)
06: S : Ls —t Y\ ,
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately
surrounding residential improvements (1) z ,..-
Otherland (2) ;_s< `. .,. , . •
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile I ,
manufactured home Garage (5) .•:.•,,.s.._: .; ._ -..._....,__i
Other improvements (6) ,.W.
Total improvements(line 4 through line 6) (7)
Total value(line 3 pits line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwithstanding any other pro •n, V,um of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real p•♦,rty o. :a manufactured home that's essed as real property may
not exceed one-half(112)of lb sse •value of the rgobileh ormanufa home.
Signature of Auditor ,. Date signed( day,
9 1.-- 19
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DISTR19U71ON:Original-County Auditor,File-Stamped Copy-Taxpayer •
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