Mobile Home_Haley CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
p�' STANDARD/SUPPLEMENTAL DEDUCTION FORM vV
ICI
`� a HC10
Slate Form 5473(R17/1-16)
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- ,
CERTIFICATION STATEMENT
I(We) 4 iffirIVIR. certify that I(we)occupi-. .t- !wig._
place of residence or am(are)buying the following d bed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this applicati n is signed, (date of signature)Mlire 2019
El Own. El Am(are)buying under recorded contract. rHt��
❑ 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 t - •- .-_•'1 -.al
0 Am(are) the shareholder, partner, or member of the entity that owns the property. lib7 qrlM..
G : • ' • • 'UDITOR
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION ��J
County 1Y 3 Township ^ r"'- Tatting .(citylit. ' Jn/
Parcel numb O^ (r`/•.I\J Is the property in question:
�A 8 qj/Li'h1L�I
/ ❑Real property 0 Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that 'ately surrounds that structixe is used to produce income,describe the use and portion
of the property utilized to produce income. _ /►I Uri
- _ 1 4' -II — to - too -coy y o� --o -g
.. • -ya.-059c.-050
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,sty,and Township Is claimant vacating a homestead?
❑ Yes 0 No •
Signature of claimant
ereby certify the above statements are true,correct,and complete. icl
Address of contact(numberand street,city,state,and ZIP code) Address of vacated homestead,if any(number and sbert,city,state,and ZIP code)
/7 /✓ i s h >r / . c ./ as Z.r 7 7e,
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
• VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements
Other land (2)
`/�`� Total land(line 1 plus line 2) (3)
(�% Residential improvements or Dwelling (4)
�, V manufactured
ured mobile/
manufactured home Garage (5)
� Other improvements (6)
t' /(� Total improvements(line 4 through line 6) (7)
\\/J�� Total value (line 3 pIts line 7) (8) /
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year) 4/
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year) .2 A I oC 3 O
STANDARD DEDUCTION ALLOWANCE 9-
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. \i
Notwithstanding any other provision,the sum of the deductions provided in IC 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 exceedrrr�� one-half(1/2)of the assessed value of the mobile home or manufactured home.
Sign of of Auditor n� / Date signed(month,day,year)
......?_z.........._
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer k..-.�Pagetof2