Mobile Home_Miller ,--, YEAR I
CLAIM FOR HOMESTEAD PROPERTY TAX FORiIn
' '•`>=1.4 STANDARD I SUPPLEMENTAL DEDUCTION OR 2 YEAR
State Form 5473(R17/1-16)
-, Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
R certify that I(we)occupied as my(our)principal
I lace of residencewe) RexlJanette or a under contract for which a Homestead Property Tax Standard
place or am(are)buying the following described real property (date of signature). I(We):Deduction is hereby claimed on the date this application is signed, 12/t312o19
0 Own. 0 Am(are)buying under recorded contract.
❑ Am(are)entitled to occupy as a tenant-stockholder of a coopetop native property under the terms of a qualified personal residence trust rative housing corporation.
Cl Have a beneficial interest in the trust or the right to occupy
0 Am(are)the shareholder, partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION
94078 'h '
CONTRACT RECORDED ,,�Occ
IIV
Recorders office where contract is recorded ` v Q `
PROPERTY DESCRIPTION
Township Taxingdistric, •
,,town,township)
Ft. Branch
County Ft. Branch 1
Gibson
Legal description Is the property in question:
Parcel number 0 Real property 0 Annually assessed mobile home(IC 6-1.1-7)
26-426-05029-00
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce Income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT Is claimant vacating a homestead?
State,County,and Township 0 Yes 0 No
Signature of claimant
I hereby certify the above.statements are true,correct,and complete. e
Address of contact(number and street,city,state,and ZIP code) Address of vacated homestead,if any(number and street,city,state,and ZIP code)
508 N. Railroad St., Lot 1, Ft. Branch, In 47648 I NON-RESIDENTIAL
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE VALUE
Land not exceeding one(1)acre immediately (1) �, r <•.
surrounding residential improvements
Other land (2)
• Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile I •
manufactured home Garage (5)
Other improvements (6) v'
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 of Auditor Date signed(month,day,year)
,,2lwllw h,1 12/13/19
STANDCION OWANCE
20 pay 20 Lesser of 60%of the assessed valueARD of theDEDU hom TesteadALL 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 property or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)
�""`` A 12/13/19
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