Mobile Home_Shade CLAIM FOR HOMESTEAD PROPERTY TAX FARM YEAR
; -''>-• STANDARD/SUPPLEMENTAL DEDUCTION —,r r7 P.7 Wf1
State Form5473(R17/1-16) HOIO CJO
Prescribed by the Departmental Local Government Finance
INSTRUCTIONS:See reverse side for filing insbuctions.
NOTE:telephone,Social Security,driver's license,state identification end federal idenhTicatlon numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
III
. 1(We) r. % • c 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
Ded •on is hereby claimed on the date this application is signed, (date of signature). I(We):Own. El Am(are)buying under recorded contract
m(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.
(���,
Social Security number of claimant's spouse(last five degls) Driver's license/identification/Other number of claimants spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number.)
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CONTRACT RECORDED
•i g„tt 'a $T s name
Recorder'sofce whervoturafOrded Record number Page
PROPERTY DESCRIPTION
County` ./. �'vO o�u1 Taxing district(city,foot' township)
i'(;Ai N�NI P
P rON GOv Legal description Is the property in question:
BS,r IDReal property Annually assessed mobile tome(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to pr up income,describe the use and portion
of the property utilized to produce income. c,
...-1.,Dzi._ ... 0 5 6 1.T.
/0
•
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes 0 No •
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(numberend street ciy,state,and ZIP code) • if any(num.- - •street city,state,=nd ZIP code , ) ,
i NON-RESIDENTIAL
...b2n-011
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE VALUE
Land not exceeding one(1)acreImmediately (1)
surrounding residential improvements •
Other land (2) { +,
Total land(line 1 plus line 2) (3)
Residential improvements or !Availing (4)
annually assessed mobile/ ti . Z, r
manufactured home Garage (5) �
,Other improvements (6) .. r- '
•
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (B)
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 othe-• • o• e sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as - to a manufactured home that is not assessed as real property may
not exceed one-half(1/2). - -. ed value of a mobile home ormanufaetured home.
Signature of Auditor Daf�signed(month,day,rear)
,&____ 1l Zo2f
DISTRIBUTION:Original-County.,•.,Fle-SStemped Copy-Taxpayer
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