Mobile Home_West Jr moo. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t STANDARD/SUPPLEMENTAL DEDUCTION FORM �7
` ' state Form 5473(Rta HC1O ��C.-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) �(y'+1e\�Pit-�-1� 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):
Own. ❑ Am(are)buying under recorded contract.
Am (are)entitled to occupy as atenant-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
It buying on contract.Fee Simple owners name
—
Recorder's office where contract is recorded Record number Page
County } ` Township P ) •Taxing
(/�diisstrrriict(city Igwna township)
Parcel number�J vim\ Legal description ✓` --=-- — 1 Is the property in question.
❑Real property Annually assessed mobile home(/C 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 u top duce income.describe the use and portion
of the property utilized to produce income
2--
C-LlZR - OS -239 - 0 o
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township Is claimant vacating a homestead?
❑ Yes El No
Signature 4 mant
I hereby certify the above statements are true,correct,and complete.
Address of co I(number and street.city,state.and ZIP code) Add:-l•f vacated homestead.if any end street.city state.and ZIP code)
5 _ �a i, — ' - Z f 1 -J�_v\1-6
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not excee ' ne(1)acre immediately surrounding c qtde I improvements (t) - '''�`'a - "' - 'L•h-
Other (2)
al tan "n plus line 2) (3) f y
'ISe giy at improve nts or Dwelling (4)
"``/� (ly assess le/ F
anufactured�hot Garage (5) _.-- —_ _ _. ?.
y �y
""••(( '� -4S'
Oth}v rd4ements (6) _ .;^�`
Totalimproveme, __.1s(" dgh line 6) (7)
Total value f rrI� , `line 7) (8) __.1
he above Is true,correct, Signature of Assessor Date signed(month,day.year)
Verit Signature of/Wditor Date signed(month.day.year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 (sser of 60%of the assessed value of the homestead or$45,000.
Notwithstanding any other vision, he sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as re •roped •r to- manufactured home that is not assessed as real properly may
not exceed one-half.,r the ass, se• alue of the mobile home or manufa I d home.
-r�q (Q..) Date gned( th.day. r)
Signature ofiWditor /! � < '� / 22
DISTRIBUTION: Original-C unty Auditor.File-Stamped Copy-Taxpayer
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