Mobile Home_Carter .,, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
� reti STANDARD/SUPPLEMENTAL DEDUCTION FORM
�‘„;".� Slate Form5473(R17/1-16) HCIO Z°! I
Prescribed by the Departmental Local Government Finance
INSTRUCTIONS:See reverse side forfifing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal Identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICAl1ON STATEMENT
• I(We) -.4. 4 J1 At 4. L " _.{{.,, certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under corttrict(car w 'ch a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, /0 # /7 (date of signature). I(We):
wn. /no t rn�+m(are)buying under recorded contract O t
4 ff,
(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
CLAIMANT'S INFORMATION
If buying on contract Fee Simple owner's name
1. -Al
A eR
Recorder's office where contract is recorded Record number 1 'P:.‹.. PL 1•,
NI
PROPERTY DESCRIPTION
County Township Taxing d'((city,town,torvnsh )
Nv GI i3Sa� /�L)/c a� I l an
�� Parcel number Legal description Is the property in question:
i •0 Real property Annually assessed mobile home(IC 6-1.1-7)
/� If any portion of the residential stnu ure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
„Ilk"
of the property utilized to produceincome. 2
4—//2 L^/—D500th7at—®O
•
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
0 Yes El No
S" ature of claimant
I hereby certify the above statements are true,correct,and complete./
Address of contact(numberand street,city,state,and ZIP code) I,�I,I Address of va omestead,if any(number end sheet city state,andZIPcode) ;
P/t. .. / tkiri K .,./ A - I `� t
'?i f ' o.( 4-7670
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately
surrounding residential improvements (1) ._.. 2 .
:
Other land (2) ...,.
Total land(line/plus tine 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile! 5
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature ofAudtor 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 provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real properly or to a manufactured home that is not assessed as real property may
not exceedii rt one-hall(1/2)of the assessed value of the mobile home ormanufactured home.
0 Si dita4.r `.� Date signed(m rdi,day: r)
.. /
Iie Zta19
DISTRI ON:Original-CountyAuddsr,File-Stamped Copy-T
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