Mobile Home_Golden CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
7 * STANDARD/SUPPLEMENTAL DEDUCTION FORM
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State Form 5473(R19 I 1-23) HC70 2.O 7—.LA..
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
- I(We) e„Q1,{"'�C),t . -0 r e 1 • certify that I(we)occupied as my(our)principal place of t....l
e......0
residence or am(are)buying the folll in describ d real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
,d-attethi}"application is signed, js_1•Qi4• (date of signature).I(We):
LldOwn. ❑Am(are)buying under recorded contract.
❑Am(are)entitled to occupy as a tenant•stockholder of a cooperative housing corporation. 1,4 0 �•f lc
❑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.
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County `� Township (/� Taxing District(city,town,to ship)
vi
•
Parcel Number Legal Description 1 Is the mouldy in question:
❑Real Property 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 immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
1,..._/ . au:, ...;t--.\ ag_,--osaTi -- (its •
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a,Hom 7
0 Yes [ I"..No
Signature of Claimant
I hereby certify the above statements are true,correct,and complete. '�`i«
Address of Contact(number and street,city,state,and ZIP coda) Address of Vacated H ante d,if any(number and street,city,state,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential improvement
Other Land (2) ,
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
.
Annually Assessed Mobile 1
Manufactured Home , Garage (5) - AUG
Other Improvements (6) r.?0Z4
Total Improvements(Line 4 through Line 6) (7) G/F3 CZ rY1�Y
Total Value(Line 3 plus Line 7) (8) S�N Co '� l
LINTY d���
Signature of Assessor Date Signed(date,m-d Jirb
I hereby certify the above is true,correct,and complete.
Verifying Action—Signature of Auditor Date Signed(date.month,year)
f
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000.
�_ Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.142 to a mobile home that $
l 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.
(„Audit Signature ^ /1t Y r� `1 II fir' ^ 11„ Date Signed gnth,day,yeart
Lst
DISTRIB ON: Original—County Auditor,File-Stamped Copy—Taxpayer �• \`ekt: ip•
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