Mobile Home_Titzer (3) M CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t 2' STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sm'a Form 5473(R17/1-18) HCIO
Ranted by to Dammam dtnml Gower/era Pounce
INSTRUCTIONS See reverse side Tor gang instructions.
NOTE:Tdepho e,Social Seaaity driver's icente,state etlrntiffCa5on and federal idenl:Eca6on numbers are co al 6-1.1-12-37.
® I(We) A a certify that I(vie) _- -
place of 1 v am(are)buying the desalbed real property under contract for Witch a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signjJt(Jra$) l i):2 018
o Own. ❑ Am(am)buying under recorded contractlHi��VV 1 1
O Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation-❑ Have a benefi ial interest in the trust or the right to occupy the property under the terms of a qualified persw�l resid
❑ Am(am)the shareholder, partner,or member of the entity that owns the property.
_ - _ �CLAd.1ANT'&UIFORIAATION � - - � 1:„.„.",..-...2,..;„.„-„,""A' ""�`
OR
'II----(legs name) Tune number d decent
Sons Stony rusher d dements appose(fast fire Mts)I(k1esImam r Idenfrffid il Othermete dmvnts spa peeve eve cape) IIssuingafate
(Alprrade ody tl epprmrfs spouse does not law a=al seamy nunem)
ct V - Ft`t,as ,' e. -, . `CONTRACT RECORDED `"-r_r=<5' <<°is:. -r r . < -e- 4- -r1
casual.
abuyi g on ca .Fee Shale oe-ef name
e ..
Recordes case when.contract's recorded Roost number Page
s• - a
Catty Township a Taxing date!pea b b orn .nshhp)
k.."
Pace renter LAPS desalpton Is to property F question
0 Real propety 0 A•esaly assessed motile ache(IC 6-1.1-7)
It any pavan a he residential structure a the lad nee meets;are(I)ame that imnialtately angzNs that structure is used to prodce income.Mmbe the use and patch
d the property vireo(to entice income.® aG - Yost, 000gek _ 00
.1 is ---.,-.1.„. J raid-FTafilii.PROPERTYYOWNED ELSEWHERE BY CLA lalatJT :_: - -. .
Ser Carat.and Township claimant eating a homestead?
0 Yea 0 No
•
I hereby certify the above statements are tam correct,, rect,and complete.
mead(rxmtlaadabst dt7; aoZfPmdq .sdtreaior itany•(marbawsync Ply Me,ed ZIP code)
0 Ires-F- elan g fkt1, rdud} N (//
,ASSESSOR USEONLY '- ASSESSEDVALUE -7 _ HOMESTE-OVA WE: �' +� NONRESIDENTIAL ^
VALUE-
Land not exceeding one y(1)acre immediate r; ..yn. 'l
surrounding residemlai improvements (1) w`l1' '; :}f :.-,.
Other land L 0rc-.-rids:i:=—= _J-. _=.':'
Total land(lire 1 plus line 2) (3)
a id y vW -73Residentia)inwonmads or &Warn (I) i4-1-
annually
assessed mobile
manufactured home Garage Dir. .e ti,r.-;.1,-.x. -_ _-
Other improvements til;-VVAltgiffilgA
Total improvements(lime.through line 6) (7)
Total value (line 3 plus fora 7) (e)
I hereby certify the above is true,correct, Signature ofA«sor pat signed(area,day,was/
and complete.
Waling action-Sgnatse c ` '- \. - - Dam sib(nn*der.SIM
.._ '- ':' -- t, a �•((,/ vSTAI:DARD 0E00CiION ALLOVIANCE '_ - a
20 pay 20 of Lesser 60% a of the assessed value of the homestead f45,000.
® . -
NohsimsteMfug any other provision,the semi of the deductions
provided in IC 6-1.1-12 to a bile home $
that is not assessed as real property orb a manufactured home that is not assessed as real properly may
not exceed onehei(1/q of the assessed value of the mobile home or manufactured home.
Sig mare dNEl Data earned(mercy day:Yawl
A� / r
DIS1RIBUTION:Original-County
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