Mobile Home_Riley (2) s-=� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
°�'_='_R\ STANDARD/SUPPLEMENTAL DEDUCTION FORM ,� ^
a' .:` ' State Form 5473(R76/1-20) HC10
'\,a1e j 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
I(We) (,51I COL t certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the folio ing described 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.
❑
Social Security number of claimant's spouse(last five 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 owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)-
Parcel num r.5° Legal description®�� Is the property in question:
❑Real property Annually assessed mobile home(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 use o pro ce income,describe the use and portion
of the property utilized to produce income.
2- 6G2s-c - °coon
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
❑ Yes ❑ No
Sig 'tu'e of claimant r.
I hereby certify the above statements are true,correct,and complete.
Addn:ss of cop ct(number and street,city,state,and ZIP code) A s of v- -ted homestea ,if a (number street,city,state,and ZIP code)
1 � I-1- IL"_, _A3n �"/(0 t
ASSESSOR USE ONLY ASSESSED VALUE I i IOMESTEAD VALUE NON- ESIDENTIAL
VALU
Land not exceeding one(1)acre immediately lir—
(1)
surrounding residential improvements
Other land (2) -
li) .'
Total land(line 1 plus line 2) (3)
r.
Residential improvements or Dwelling (4) ,
annually assessed mobile/ + 1,. -
manufactured home Garage (5) �0�0 r
Other improvements (6) �� Q ` v,
Total improvements(line 4 through line 6) (7) O D I
gl R
Total value (line 3 plus line 7) (8) • _Y!I11�". �11 Q
Si- ature of Assessor ' I P 'Date signed(month,day,year)
I hereby certify the above is true,correct,
and complete. - GO
Verifying action-Signature of Auditor \�SQN Date signed(month,day,year)
G V
S I:4NDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed v•ue of e homestead or$45,000.
Notwithstanding any other v idn,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as rea ro rty or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)o he ssessed value f the mobile anufactured home.
Signature of Auditor c Date s ned(mo th,day,year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Tax r
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