Mobile Home_Miller (2) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a :* STANDARD/SUPPLEMENTAL DEDUCTION FORM
tt. Z431.40"(, ..;�:� State Form 5473(R18!1-20) HC10
;;;-!" 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) SC 40 - * . m i Ile f 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):
R'Own. ❑ Am(are)buying under recorded contract.
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
O Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
C/ns O'V',
Recorder's office where contract is recorded CO�^'T i•ipiv.
.'nu •-r` Page
,Y /Al V•
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
C' PC—\ r\Ce to roc _-\
Parcel number Legal description Is the property in question:
.krortit ` )
J
-® ' ^7 O o ❑Real property nnually assessed mobile home(IC 6-i.1-7)
If any portion of th residential structure`o the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant v cating a homestead?
❑ Yes NNo
Signature alma
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state,and ZIP code) Address of vacated home Lead,if any(nu er and street,city,state,and ZIP code)
34 \. rn . -Pri mac" • tit . u • 0
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other improvements (6)
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-xceed one-half(1/2)of the asse e value of the mobile home or manufactured home.
Sig Ile of Auditor Datelsignerd(month,day,year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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