Mobile Home_Loeffler CLAIM FOR HOMESTEAD PROPERTY TAX of;�,�
STANDARD/SUPPLEMENTAL DEDUCTION FORM
1. HctO
. a ,' State Form 5473(R17/1-16)
Prescribed by the Deparbnentof Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state idenffffcation and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT -
t(We) 1 r 1 i_ / certify that I(we).. .died;- .y(our)pn '! •
place of residence or am IV
)buying the following d ' d real property under contract for which a Hom --r d rh e•1-',-' ' rr-• "-7e
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract DEC 19 2019
❑ 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
❑ Am(are)the shareholder,partner,or member of the entity that owns the property. /,,.�rl
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing di•(city,teen,townshlp) '
Parcel number Legal description /6 )C 7 , Is the property in question:
/99 u r ❑Real property ,ttnnuallyassessed mobile home(IC 641-7)
If any portion of the residential structure or the land not exceeding rue(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
a6- y x s-'o so'so - D.a , -
1
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes,❑No '
3/Signature of claimant
I hereby certify the above statements are true,correct,and complete
Address of contact(number-and street city,state,and ZIP code) Address estead,if any(number nd street,city,state,and ZIP code)
X 5� Lk) c� e C to 03 Q ci cl ci. n t 11�1 41 lo-1 0 :.. ..
ASSESSOR USE ONLY j ASSESSED VALUE 1 HOMESTEAD VALUE 4 NON-RESIDENTIAL
I I VALUE
Land not exceeding one(1)acre Immediately (�) 7. '
surrounding residential improvements
t
Other land (2) ..>- _. ..
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile! s.
44
manufactured home Garage (5) �s
r y:_{
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 ofAud for 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 property orb 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 f Auditor , Date signed(month,day,year)
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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