Mobile Home_Miller (4) i
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ax� �.1 CLAIM FOR HOMESTEAD PROPERTY TAX
7* STANDARD/SUPPLEMENTAL DEDUCTION FORM
HC10 G' A
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State Form 5473(R19/1-23) 1
'" 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.
t r `' J'' CERTIFICATION STATEMENT
I(We) LW. .e- Q _h d f certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the fofiayyit�q�ee crip �e»lpr petty un err contract for which a omestead Property Tax Standard Deduction is hereby claimed on the
dateat this application is signed, (�G�jfoc'-j/ (, (date of signature).I(We):
...Own. ❑Am(are)buying under recorded contract.
/❑An,(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
0 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.
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded / Record Number Page
1 PROPERTY DESCRIPTION
Township„•� Taxing Df t�,f WTI own
Parcel Number Legal Description Is the property in question:
0 Real PropertyAnnualty 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.
,96 — 49 9 -Osg. /7G--00
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
Yes ❑No ,
Signature ot„Gld a-t
I here y certify the above statements are true,correct,and complete. -
Addr Cbnlad{r lber and street,city,state,",ZIP Vet ; 7 Ad res of led o estea At ny(nu r and street,o' state,a ZIP code
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ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE ''NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
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V.,D
Total Land(line 1 plus line 2) (3)
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Residential Improvements or Dwelling (4) nrl A
,Ai°
Annually Assessed Mobile) u 't
Manufactured Home Garage (5) SAP si
Other Improvements (6) / /] '/(yt,
464.414)
Total Improvements(Line 4 through Line 6) (7) 1r _,/ (,�'.r,1 A �"[Q�
s 11�
Total Value(Line 3 plus Line 7) (6) G' ;B'SpN C'du�aT
Signature of Assessor Date Signed(date,month.year)
I hereby certify the above is true,correct,and complete. `r�
Verifying Action—Signature of Auditor + Date Signed(date,month,year) ��\V
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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 $
l is not assessed as real property or to a manufactured home that is not assessed as real property may not
exceed 9e-half(1/2)of the assessed vat f the mobile home or n{pnufactured home.
.. Sign ebf Audit ` li:���,Imo, / Data gn �,{mo/hZ/��
r dl•) Y rr r, �J�1�A Q lilt/1/ �J'''2
DISTRIBUTION:Original-County Auditor,Fite-Stamped Copy-Taxpayer , >�V
Page 1 of 2 /)0
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$ • $
11111 HillII 11111 II 11 III II 111011111111
IN Title Application-2807-9/2021 -TitleApp11125 NMLS#MLO#004854370-00002
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Sales Person ID: 372859
1111110 11111 I III II II.
A-Z Follow-Up-10/2023-AZFIIw300 NMLS#1561 MLO#2472208 004854370-00002
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$ * $
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