Mobile Home_Randall CLAIM FOR HOMESTEAD PROPERTY TAX YEAR-,
c STANDARD/SUPPLEMENTAL DEDUCTION FORMHC1 r/7
State Form 5473(R18/1-20) 2
^�, 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)— AMER S 40B10 _ _ certify that I(we)occupied as my(our)principal
I place of residence or am are)buying the following described real pr d r .nIct for which a Homestead Property Tax Standard
De uction is hereby claimed on the date this application is signed, _.__.__. (date of signature). I(We):
I
I Own. ❑ Am(are)buying under recorde contr ct.
• ❑ m (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,
LI 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 off here contract is recorded Record number Page
PROPERTY DESCRIPTION
County ` n Township r"� Taxing district(city town,township)
____._ description ....-_____ Is the property in question.
Parcel number Legalp inn
I []Real property _ Annually assessed mobile home(IC 6-1.1-7)
If any portion of the eiide tial structure or the land not exceeding one(1)acre that immediately surrounds that structure is used o pr duce income describe the use and portion
of the property utilized to produce income
2_,�,_._ L\2 ( -0.s--6.3 —0 -
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant v..W. ng a homestead?
El Yes ' No
Virg nat f I t.
1--I hereby certify the above statements are true,correct and complete( ,. --'_-,.��/T�-�=-SJ
Address of contact(number and street.city state.and ZIP code) Address of vacated hom�estteead ift an f god street.,t state.and ZIPC code)
. -'�-a .) :i. T ,,•-J n -
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I WON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately x(1)
surrounding residential improvements
Other land _.._..._—
�i Total land(line 1 plus li
Residential improvemen s or Dwelling (4) -__ ._�..__ ---------- r'" t
annually assessed mobile I _
Gard a (5)
manufactured home `�'
f --MAR-0-7 2022
Other improvements (6) g '.^'k "" ��� - 1
L Total improvements(II/jree 4-th�ro_ugh line)6) �,{i (7)_ ,
Total value (line 3 __.._ -----
UD)7R#Rure of Assessor Date signed(month day year)
l I hereby certify the a , t,
and complete.I
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 lC 6-1.1-12 to a mobile home S
that is not assessed as real property or to a manuf- re. ••me that is not assessed as real property may
not exceed one-half(1/2) f the assessed valuiAll=obile •me or manufactured home.
Signature of Autlitp>;n -' Date signed( ont�y.year
1/
DISTRIBUTION: Original•County Auditor.File-Stempe- opy-'rasps
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