Mobile Home_Groves / CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR
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STANDARD I SUPPLEMENTAL DEDUCTION FORM E !�---
'State Form 5473(R19/1-23) HC10 � 2
/ei, Prescribed by the Department of Local Government Fnance s�
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
n
I(We) e� c oe__.‹, certify that I(we)occupied as my(our)principal place of
residence or am(are)buying Ti win d``escn.ed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date t 1 d- I-Z pplication is signed. 3 (date of signature) I(We)
n ❑Am(are)buying under recorded contract
❑Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
El 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
CLAIMANT'S INFORMATION
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
Co Township Taxing Distnct(city town,township) I
Parcel Number Legal Description Ic o y in question
eat Property 0 Annually Assessed Mote Hare(IC 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 income,describe the use and portion
of the property utilized to produce income
(:-.- \....Q --•"' 1..."-A .dr.: ,..... CY----AD".--1.S......00
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County.and Township Is Claimant Vacating a Homes T
❑Yes
i Si nature of Claimapt /�� V
I hereby certify the above statements are true.correct,and complete ./�/'L /�J (`/^ tQ l
Address of Contact(number and street.city.state and ZIP code) I Address of'VacaattedC-Homestea• if any(number Dnd street city.state and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL V!_Ur
Land Not cReside One Acre Immediately (1) j
Surrounding
ingng Residential Improvement
Other Land (2) —1"14��
Total Land(line 1 plus line 2) (3) C ]
Residential Improvements or Dwelling (4) `�+1��
. Annually Assessed Mobile I -
Manufactured Home Garage (6)• 94eS ��
Other Improvements (6) 041COS i�1 \`\
Total Improvements(Line 4 through Line 6) (7) tiT�',9�0 (�
Total Value(Line 3 plus Line 7) (8) //```'OjVVV__JJJ.. \ 1
Signature of Assessor Date Signed(date.month.year) �J
I hereby certify the above is true,correct,and complete.
Verifying Action-Signature of Auditor Date Signed(date.month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or 548,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1 1-12 to a mobile home that 5
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
Signature of Auditor Date Signed(month. ay year
YI 1
�' � \ INS a, • lL ,>�-_ 1 day
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DISTRIBUTION: Original-County Auditor.File-Stamped Copy-Taxpayer
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