Mobile Home_Bota CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(R 17 l 1-16) HCIO
Prescribed by the Department of Local Government Finance 4
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
lik
I(We) /. 1 certify that I(we)occupied as my(our)principal
place of residen••or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Ded on is he .y claimed on the date this application is signed, (date of signature). I(We):
Own. CI (are)buying under recorded contract.
m(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
ClAm(are)the shareholder, partner, or member of the entity that owns the property.
(Applicable only if applicant's spouse does not have a social security number.)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name FIL
-1 )ber
Recorder's office where contract is recorded Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township �w
Parcel number Legal description lathe•...,i.t' I' ii/;,I►g/y�y ly
ri1B ,.. Y-+.. TY•treffi. sed mobile home(1C 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 used to produce uw„re,describe the use and portion
of the property utilized to produce income.
a 7 6- tiag- d Sa47� -D o
,n PROPERTY OWNED ELSEWHERE BY CLAIMANT
C \Q.)1\)
State,County,and Township Is claimant vacating a homestead?
'
❑ Yes ET No
Signature,•aimant n /
I hereby certify the above statements are true,correct,and complete. // 64 sirs....._
Address of contact(numberand sheet,city,state,and ZIP code) - _,,, , ._.. (number and s state,and ZIP..•:)lib 1 1^
1 Q 7 rill,
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RES,DENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (8)
I 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 IC 6-1.1-12 to a mobile home $ r/►
that is not-. essed as real property or to a manufactured home that is not asse as tea party may JG/'
not exce' one-half(/11/2)of the assessed value of the mobile home or man red home. 0185 ttt000111YYY
Signature •Auditor / 4 Date si month,day,
it•_ ,1111rA, 10 40(-- ,____c_ 111111\
e ISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of 2 ii az2 7/090/9/ e-e •