Mobile Home_Beadle 4•J":_ ;. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
,1 t, STANDARD/SUPPLEMENTAL DEDUCTION
FORM
s' State Form 5473(R18/1-20) HC10Mil
\ ,Voy. ' Prescribed by the Department of Local Government F inane,
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential nder IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) /Am.A_Air ,- - i er h.T r"l IInMi`,cupied as my(our)principal
place o residence or am(are)buying the following described real pro.f•rty under contract for which a Home ead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date• signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract.
0 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.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township y'r riot(crTy town,township)
SOS -
Parcel number Legal descnplron I Is the property in question.
11-4� re
-,w,35-oo ❑Real property nnually assessed mobile home(IC 6-f f-7)
IfIf(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 the use and portion
of the property utilized to produce income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant 1.grromestead?
0 Yes 01; o
/Si lure of laimant
I hereby certify the above statements are true,correct,and complete.x
X
Addr'ss of contact(number nd s -et,c tate.and ZlPcode). ip Address of vacated omeste .,ifany(number and street.city.State.and ZIP code)
8 r getAA / 1? 7
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
I Land not exceeding one(1)acre immediately
surrounding residential improvements (1I -- *iif ! 'x r
Other land (2) t'3f�srfv,
^ Total land(line 1 plus line 2) (3)
C`l Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5) waew;014k:r.l:
(� •
(�� Other improvements (6) `5 ;arA {
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 .a-si oath,d r) 11)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000. MAR 1 1 I 2
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 assessed value of the mobile home or manufactured home.
CA�fl/ /JQ��4ma
Signature of Auditor A �j m3Nl x B"eL rAUDITO ��
DI r, ---d —�`,,
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer �/a�a3
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