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•!^•gi CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
11 STANDARD/SUPPLEMENTAL DEDUCTION FORM
Slate Form 5473(RIB 11-20) HC10 i�2I
•• 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
place of residence or am(are)buying the following described real prmerty kinder contract for which a Homestead Property Tax Standard
diome ction is hereby claimed on the date this application is signed, -/ •1 L•20 Z.l •
I(we) ...Age- AMPA‘k, " - certify that I(we)occupied as my(our)principal
Own. D Am(are)buying under recorded contract.• m (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.
■ Am (are) the shareholder, partner, or member of the entity that owns the property.
Name of claimant's spouse(legal name)
ce- ,,, -dc,1---0,1-8- d
Social Security number of claimant's spouse(last five digits) Driver's license/Ide ification/Other number of claimant's spouse(last five digits) Issuing State
(Apphcable only tI applicant's spouse does not have a social security number.)
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name
Recordees office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township ��- Taxing district(city,town,township)
l/I1 J O ,
Parcel number I Legal description Is the property in question'
U ❑Real property Annually assessed mobile home(IC 6-1.1-7)
I If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is u d to pro uce income,describe the use and portion
of the property utilized to produce incon'
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township IFINIMENI11111111 Is claimant va•= . .
W
❑ Yes ■I hereby certify the above statements are true,correct,and complet. ,
' Signature of claimant
A. . _ -
Address of vacated homes,ad.if any(number and street. ,state,and ZIP code)
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
` O VALUE
\Y^ Land not exceeding one(1)acre immediately (1)
Iratill ID -
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) J1 it_ 1 2 '
annually assessed mobile/ —
manufactured home Garage (5)
Other improvements (6) `��y /) ', • r
(((���� / Total improvements(line 4 through line 6) (7) / ci VON COUNT
'U�1TOR
(��-/v Total value (line 3 plus line 7) (8)
k
` v I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day.year)
: and complete.
^/ �\q....)\*"
Verifying action-Signaturo 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 $
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 assesse of tb�mobile home or manufactured home.
Si at o Audi of r\ \ Da i ell(mon ar) _
1r
DISTRIBUTION: Original-County Auditor.Fit tamp Co -Taxpayer
Page 1 of 2 ....I
•
MANUFACTURED (MOBILE) HOME PERMIT
SAS
Sec..or.A-F: I 7...7: a::o-. B -Tr.-n. --i. Tlt;� _...c -. _ .; : . J 'iato
/NSTRUCTIO,ts:
1- A rnobi!e home me,rot b-mo.,ard from ores location to❑ _, ur'I9SS the o,4,^.er Gore ra a n _ home from tre co:"', , aa,s
2 The Bureau of firctor VehActes ma/rot transfer t:e title to a r-1ob e home -cha?g-'a a c s rle to hip me. _ -a r,', _
pe'."ii:to transfer try:.a f Om the C;unry treas::'e'. CO E-1.:
3 A coJnt;tree.,_,". - ss:a .;i-.r .. _ _. _ a-a as s._,_ ; __ __
. : _ _ pa, _ • _ _ __ : _ •_._ d The pe • _ a . a_to s;;__ ° e
?^;pij to a mob:e IC'9-22-1.J or IC ., - - - 4 isiates - "`
separate perm.
r" i., - : - _-. i
NOTE: t. _ a e ea =7. to a :e-t-e da` _ _
_.. _ ' -;a:o�.-7 a a, term.t
ATTENTION: MOVER,HAULER,OR TOWER
c; mc,- bile home -r- „r the. ne _ e ,,, ov mobile
home d
A,r.8'3�?n ,. ^,'3 engaged t0 �a mobile may .�`.F"i'i�Ca t`lat Sc� :. a3 ;�,�.. ..r p'a�= i�n:r~vrl.�a r�,."-!to move.the(T1:��DI,6 a^.��
;no permit _._..?.. .�,"o-e t'a^ ninety (90;days be OD the date of the propose::m..:e.The!'tole-snail visibly display toe permit'while the mobile home
Is 1 -a-as I-'e rn ,_ m_•st re., c the palm t to the ...,r_ t. a motile home „ e" tne rr Die _ `eted. IC 6-1 1-7-11
SECTION A-MOVING PERMIT
_.,-,-------- ---- Date'., .s.. _. - r?8, i=`}
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Z.D Date
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