Mobile Home_Bittner CLAIM FOR HOMESTEAD PROPERTY TAX
' STANDARD/SUPPLEMENTAL DE DEDUCTION FORM YEAR
-a
/ State Form 5473(R18/1-20) HC10
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. f � `i )a'
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential un.[.- 6 J.1-t-37.
CERTIFICATION STATEMENT
I(We) - 'i certify that I(we)occupied as my(our)principal
place of reside e or am(ar buying the following described real property under contract for which a HomesteadMf yjT andprd
Deduction is hereby claime on the date this application is signed, (date of signaTure). I(P 11LU
❑ 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 pe��§t.
❑
)
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 trict(city,town,township)
Parcel number Legal description /C` /_7 Is the property in question: �{
4n 7/ 112 'w b C Qa,,, Q
QQ / 9 75 may( S fP ❑Real property ,k: nually 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 used to produce income,describe the use and portion
of the property utilized to produce income.
1
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating homestead?
❑ Yes �G"-
i Lure of cla' ant
I hereby certify the above statements are true,correct,and complete.
Ad. •ss ofc matt fin tuber end street,city state,nd 7,IP,ppde)n H
rice„ry f�(� Address vacated homestead,if any(number and street,city,state,and ZIP code)
'Ir.1J fk1�.nOVI, F-fl//`/ j -76 0
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
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 exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Dale signed(month,day,year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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