Mobile Home_Williams (3) 0•1na -;CLAIM FOR,HOMESTEAD_PRQPERTY TAX ,,• . ;.YEAR
4, f i•q `-STANDARD/'SUPPLEMENTAL DEDUCTION FORM
2\ '`t' State Form 5473(R18/1-20) HC1 O ZO 70
\ Prescribed by the Department of Local Government Finance
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INSTRUCTIONS:See reverse side for filing instructions.
NOTE;Telephone,Social Secunty,_dnver's license,state identification and,federal identification numbers are confidential under IC 6-1.1-122=3T.
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/1 CERTIFICATION STATEMENT
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I(We) . O,S�Lka, � \ l 1.(.1LmS 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, 1 a—'g—,,O1.O(date of signature). I(We):
Own. 0 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.
CONTRACT RECORDED
If buying on contract,Feb Simple owners'name - - " - I , '
•
,.' •r G,B '
Recorders office where contract is recorded SQ tt r -' .'•rd=er Page
PROPERTY DESCRIPTION
County ' Township. ,. Taxing district(city,town,township) - • '-
C�‘bsO� Opt-�s�'� 1(e , •
Parcel number Legal description Is the property in question:' '
P (,=1? ❑Real property nually assessed mobile home(/C 6-1.1-7)
f any portion of the residential structure or the land n exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe th'e use and portion
of the property utilized to produce income.
cZ.6— yas --OSOUri —0O
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township' - ' -• Is'Gaimarit va^catin�g a omestead?
Yes .4
qci
Signature of clai •
`,�^'wid����
I hereby certify the above statements are true,correct,and complete. )j
Address of contact(number and street,city,state,and ZIF'
PP `!code)(/��) l Address o ated homestead,if any(number and street,.city,_state,and ZIP code)
AI .�( ` 17- . - vs .1te . 9 A' r
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-REASIDENTIAL
VUE
Land not exceeding one(1)acre immediately r
surrounding residential improvements . ' (1) •
Other land (2) _
�S
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) ' r f' �9 2U7
annually assessed mobile I a`1. -
,manufactured home- Garage (5)
Other improvements (6) . . I �'
,` t \t�r
Total improvements(line 4 through line 6) (7) O,11 "1,
Fk,p
Total value (line 3 plus line 7) (8) G‘BSG
I hereby certify the above is true,correct, kj
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 ass ssed value of the mobile home or manufactured home.
Sig ature of Auditor - Date signed(month,day year)
• _ i if.N‘SRA___4)
V Wig.-ac e-
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpay
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