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Mobile Home_Huante •rnr CLAIM FOR HOMESTEAD PROPERTY TAX YEAR 3 ? STANDARD/.SUPPLEMENTAL DEDUCTION FORM }'\ L ' State Form 5473(R1 a/1-20) ��� .� HC10 Z�2.0 o l 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) SO Cc 'vO Wile e . 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 Deduction is hereby claimed on the date this application is signed, (date of signature). I(We): 'JOwn. ❑ Am(are)buying under recorded contract. LI Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. LI 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. ) 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 numb J0 Legal descri ti©Z6. 9 P 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 p duce income,describe the use and portion of the property utilized to produce income. 2C-- LtZ6 � 0S—'031 -00 . PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is claimant vacating a homestead? ❑ Yes ❑ No Signature of cl' I hereby certify the above statements are true,correct,and complete. X Address of contact(number and street,city,state,and ZIP code) /\ Addres o v ,'any(nu ber d street,city,state,and ZIP code) o s �a,.dan•f- 11 di Yslanck L I ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE 11 1.9—V t.y . Land not exceedir.- :(1)acre immediately . surrounding r th provements (1) - Other Ian (2)anbles line (3) F IL `- t y . 1 la!improve c(s or Dwelling (4) a ually asses Tb/ manufactyrth / Garage (5) ('7 Othe rovements` .de, ^^``�Ol (6) OCT �O�O Total improvemen���l5.. t(uv�AgHime 6) (7) / Total valu�''ih e � 7)PPPPPP""''' (8) ' I hereby gf ne above is true,correct, Signature of Assessor G I B S O N'COUNTY AU D Pl tied(month,day,year) VegAg 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 re- ror- or to a manufactured home that is not assessed as real property may not exceed one-half(1/2).f th:..essed value of the m ' r manufactured home. Signature of Auditor 14 n Date sig d(moot,�d}ay,�year) DISTRIBUTION:Original-County Auditor,File-Stamped Copy- a r Page 1 of 2