Mobile Home_Bailey CLAIM FOR HOMESTEAD PROPERTY TAX
® ' -4' STANDARD/SUPPLEMENTAL DEDUCTION ROIL YEAR
,� State Form 5473(R17/1-16) ROI0
Prescribed by rite Departmentof Local Government Finance
INSTRUCTIONS:See reverse side forfbng instructions.
NOTE-Telephone,Social Security,driver's license,state identification and federal identdreafion numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
• t(We) AA ,_ /.i EINI _ certify that I(we)occu• - as r y «ur)p'+ 4.
place of residence or am(- si buying the following described /property under contract for which a HomestX. Pro< )5 ax : a r•
Deduction is hereby claimed on the date this application is sig •, (date of signature). I(We):
❑ Own. El Am(are)buying under recorded contract D E C 1 $ 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 trust
❑ Am(are)the shareholder,partner,or member of the entity that owns the property. / '--I._ri
Social Security number of claimant's spouse(fast rive digits) Driver's license/identification/Other number of claimant's spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number.)
CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing d- '(city,town,township)
Parcel number Legal description 4 A Is the property in question: r�r�
/9 9 S< . ❑Real properly ,tignnualiyassessed mobile home(IC 6-1.1-7)
If any porton of the residential structure or the land not exceeding one(1) ere that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
26 - 41a7 — oo637 _ co
PROPERTY'OWNED ELSEWHERE BY CLAIMANT
State,County,and Tip Is claimant vacating a homestead?
0 Yes ❑No '
g t,ofdal .i n
I hereby certify the above statements are true,corre
ct,and complete. ay e , �l.J „
ddressofcontact(numberandsrreel;city,state,andZIPcode) Address of --J•homestead,if any mber and street city state and ZIP code)
500 uj Wcor(lock , S Lo4' 8-1 l Princei-on, =tit bi.' (olO
ASSESSOR USE ONLY I ASSESSED VALUE f HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1) 4 f
surrounding residential improvements -
Otherland (2) _
Total land(line 9 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile 1
manufactured home Garage (5) • ,, .,
a i .t
Other improvements (6) .s:,- _,.....-_..,._-1.::: .,...Z_
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)
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 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 o udder / Date signed(month,day,year)
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer ..."1"4—......-- .
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