Mobile Home_Treadway •:: CLAIM FOR HOMESTEAD PROPERTY TAX .AR
STANDARD/SUPPLEMENTAL DEDUCTION FORMS 6/.� �/
A State Form 5473(R18/1-20) HC10 I r(J `'
iv. ..1 : a 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) lir 1f f -•I rt k���• certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following describefJ<f:lal property under contr et for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, 3- 'l— Z. 2.-2_2.-2_- (date of signature). I(We):
L�c�duwn. ❑ 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.
El Am (are)the shareholder,partner, or member of the entity that owns the property.
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
•
County Township Taxing district(city town,township)
►hte S .• 0 a1 ((e._ _ ,
Parcel number Legal description !Is the properly in question:
❑Real property nnually assessed�lpyile home(IC bf.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 l4J(Q s 9p y/
of the property utilized to produce income ^ —. � ■/y�-.-��� ^ f 4V22
eel ` ' O"D,C s _.V✓�/,pL.-a G1BS•.3N Coo. -'
0 Q
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vacating-homestead?
❑ Yes
Signature clai
I hereby certify the above statements are true,correct,and complete. �� CIM �'
Address of contact(number and street,city,state.G end ZIP code) Address o/vaca ed homestead,it any(number end street.city,state P code)
2' - ÷ I• 5U 7 6 f c:Rt1J•
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL.
VALUE
Land not exceeding one(1)acre Immediately (1) T.+'
surrounding residential improvements _ �
Other land (2) .rWr��i Ir'�'Z
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5) - -
s..,-a
Other Improvements (6) _ �,���, -�a
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (8) _-
1 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/C 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 Date signed(month,day.year)
•
\\>� Ar 3- \T3- \1A.��J nc- 3-9—2 02.-2--
DISTRIBIlf1ON: Original-County Auditor.File-Stamped Copy-Taxpayer
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