Mobile Home_Chapman CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' STANDARD/SUPPLEMENTAL DEDUCTION FORM
=m f*2 State Form 5473(R17/1-16) HC10
Prescribed by the Departmental Loral Government Finance
INSTRUCTIONS:See reverse side forfiEng instructions.
NOTE Telephone,Social Security,driver's license,state identification acid federalidenhfication numbers are confidential under1C 6-1.1-12-37.
CERTIFICATION STATEMENT
• I(We) VIII ;. . . VI' :ti ZN 4 certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following d- ''bed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract
❑ 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.
If buying on contract,Fee Simple owner's name ' '
G!BSbN 'I'Tri j/
Recorder's office where contract is recorded - Record number COUNT q '
Y AUDiroR
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
•
•
Parcel number Legal description
^^ Is the property in question:
c . o— Lk — Lq LA ^U Y 1 0 Real property yassessed moble home(IC 6-1.1-7)
If any portion of the residential structure or the tan not exceeding a(1)acre that immedatelyy surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
(q' 7o 11 w
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
0 Yes ❑ o '
.Signat (claimant
I hereby certify the above statements are true,correct,and complete.
Add •• =ct(numberandsheet state1andZIP ctuatt. Ltddressa vacated homestead,if any(numberand ,city,blatu,and ZIP code)
a4
ASSESSOR USE ONLY I ASSESSED VALUE 1 HOMESTEAD VALUE NON-RESIDENTIAL
I t VALUE
Land not exceeding one(1)acre immediately •
surrounding residential improvements (1) E' ._ _ .,AP -:
Other land (2)
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4) „,t z +
annually assessed mobile/
manufactured home Garage (5) '
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value(tine 3 plow fine 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 Data 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 a-half(1/2)of fhe assessed value of the mobile home or manufactured home.
Signature of or DatesigneA(moMlcrl
u-C,^^JJJJII 33
DISTRIBUTION:Original-County Auddat,File-Stamped Copy-Taxpayer
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