Mobile Home_Fugate I'mtAAcL S1rtk4Q
4 t a if>" CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
l 401 s.: STANDARD 1 SUPPLEMENTAL DEDUCTION FORM i
,M ec A- `� State Form 5473(R19 t 1-23) HCIQ V� t
` t ll1J�i a»'� Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. y, ,
�L NOTE:Telephone,Social Security,driver's license,state ident�..• ,i .t :=e.1 identili rt. l�ekr y't ,C onfidential under IC 6-1.1-12-37.
( CERTIFICATION STATEMENT
I(We) MAN ill - 'r��. . certify that I(we)occupied as my(our)principal place of
^t�►•tMV residence or am(are)buying the foil. I g describe ra property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
i date this application is signed, (date of signature).I(We):
❑Ovm. ❑Am(are)buying under recorded contract.
El 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.
If Buying on Contract,Fee Simple Owner's Name .
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County J� Township Taxing District(c' ,tow to nsi `n p) `
Parcel Number Legal Description Is th:. .pe '-question:
Real Property flatly 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 urn"nds that structure is used to odu income,describe the use and portion
of the property utilized to produce
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacati g a mestead7
)) 0 Yes No
1 J Signature moot
I hereby certify the above statements are true,correct,and complete.
• .=s of Coetg�-(arum and street,;state,and ZIP rro � i I Address of VacatedHorpeste`�it zy1r'tumber and street,city,slate,and ZIP code)
C C`1\ cil —"-1l 1
ASSESSOR USE ONLY /ASSESSED VALUE HOMESTEAD VALUE '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 I -
Manufactured Home Garage (5) '`�
Other improvements (6)
���.,:01 , '. ,,bl '.
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8) Q/.9 ' -/ r<OG
Signature of Assessor t7�Q t ,, �^ Date Signed(date,month,year)
I hereby certify the above is true,correct,and complete. (/� tC/.�
Verifying Action-Signature of Auditor T Y�GS�r Date Signed(date,month,year)
. /r1
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 6-1.1-12 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 ome or manufactured home.
Signature of Auditor op Date Signed(month,day,year)
in kr'
DISTRIBUTION:Original-County Auditor,File-Stamped xpayor 1 , )
Page 1 of 2 \J(^�� `
V
. _
,.....*5,-..i.g
MANUFACTURED (MOBILE) HOME PERMIT
IP it.
.. _, P,,--.F-r..-.,-.•::-, ,-...i_br..,. 1----,u- .-,...--,11,,-; --- --_-.'--- ,I.,.-. '::,,,,2- r- t
,,„------,v
Section A- For Uolirlo ASectOn E - MrsFerf,: q ldie
„TE . . ,.. ).,,,y,!,,,„.,.,,,. „.... _ .„ hot'.'-,'i ..,...' .1 ,,:i f,i 3..;f';'
. - . - -- • • - - - -
/HS TRUC:DONS
1 4,77,:,u6,ficry;,:.0051 n)(4-.6,r-,,,Jyerif.,,,m 0,.c inc:at,,,,,t),..i,,,,-,Inz:. t.,:iless Ire(i,.....,r,,-,',,Iti'.i)73 a pe,trilt i0 1,10'..4,';12:-7.•(r.)04.5 I icont loot tile co' iv, tre-a3„,r,,,--
2 The,Btiri.O0I:Of AbDtor V;;,...;:lit".10.•>(17,3/rot trxts`et'The bltle tr...--,.tho,6.`,..-;I......the o chafrge/1-3":103;ir?an/ira.7:15.-; ...Jo tle tale to a mobtia home,tin,,) s ti, ,0.,..„6,, ..tt.„„s..,
5-ma to transfer the tit.'e,Trim tre county treasty'e•• tic':6-1 7-7-1),
3 A fr.„:;iinty treasurer sp,3ii:::s,IF,a ii-..-1,1:4 tA,:-!;-17 p's 1-•,-_,;C1,1,,e j:(.1-:,.1'2E..;-,r',..)•,,a- '":(r.:1:1.3;-',' the-Ice t;e trribits home if The taxes,spal as-sess,nents interest p-,n34;ay;
judgments.and costs that a,..s tide aori 0,1y a Olt?on ti-e no-)bite IL-I13t,'/),-7.-e heel?nod Ina permit shall slate the d3!.ft,.;issiied The trees:If-et rh,;.s:r.,3she in,-,-:
„.-.,erm,t not late(tha,.3`.y.;(2't.),,s"ass cloys(a(c1:1,-;ht?g,•,.-ei..,a,,its a-si nc:•,,.-b:,5:,E,Ft;,-;,-(17iri date the treas.:re•reoe-s-ss a completes pe.-nt appcatfrf; dr,.5-1 1-7-t ri
..; A rnobtl.:horns o,y-er:,;,3,.)s;..-...ils toe frt-;4.14.,:'I-orne t,...,Of--..-t"e't,,3*11.)%1,do 1,3e o,,,cha.,,,,-4,:th th.e permit re3,..,tred befo,e the sa,,,,,,is r,y1.3t;:nrria;x1 This 0h1:9.4:or
cf?,,-.)3 not apply I-)a mob,,7., hcr,n off,.---ecl for s:lie it hr a;..rIc;.'.iti..:-..-r IC 9-22-1 5(.1'IC.9-22-I 7 ('C 9-1 1-7,/ 4; A pe'u-s'v,,t1.:),10tO/t,-...3 thr3 COrtlint,a Ci95.3 C
infraction tIC 6-1 7-7-14
5 A roost Ic home oy.17.::-mu--i press-,::a copy of ths pe'r.s.l')ti',B?.',3?c..:of Ak't il Ii'....i.P:A;;;-+when awl:plc,'f9r Me Iran:fr: If tne r,no9 hc.rno is cr;0.,•;,9,efj .3
sepii-o!-_,:pernb.tmtis:t be req.issred pnc9 tl rro.,•09
5 A Frain 1 l'Hohne of P,',a,:ing of M-2iy'e.I In---e Upc,r11._;?;--!:,-LOF — .-*-:.r c-s f.'s-./,WI)?tf'? 3-_-?)E.S.:3,2? v.,/i'm trI-d:, ,.-30)ha,s abs-,-ti:,,,da..i nf p'xern.3,:•of ri-..2 nroi.91i.::
il),-;,,,,,tiC 5-1 1-7-3;
7 Th.„.regyretret,t 1'3(11)1,3,')a/-,e.int I)trC.,-‘3,-Cr t(tIT?,-It-O,I,:?.)to, 1!ITO:6'ft/I„rf,,,,::12,...7,i,I r01':ICC,/i",?.?)trOl:NIE):"...%-:',-.7.,t,'';'?'IS of5,tte,1 hi! srite.r.,..a,ctc:J"0,7,i-,,
lc 9-22-1 5 lc 9.22.7 7 or Jo 6_1 1.23 5 for 4,1,,f.,3,;cferrt/ttf,y f,ont tI"O O?„.t?Ot 7 (IC,6-/ /-7-1.-ilet‘
.l.,:= 1:7-,;;-,...-;•ent;-v or prl.;cie,.;i.1;re•-s,).9,e,.-t-t--..,5:`,.1.:j This re;,lt,t :tC ti-' I--'-I t..1- I • .' St)r-.:,.iss.red Ti!te _ ' Crit..-r 0.-,,2,- ' 5,,,,i..,,..1j1.I,it's,-,.:.-.0,-D,s,---, sal
NOTE: A permit t)t,',-)J.:: ;)?"transfer tate:to a mohtle.home-s.::.)l-es.r:t.,et:t i 90 i d.-.-i,s=lite.-tit:'late th,e.;:;).int., treasurer;ssue.s it t,',he.,the permq
efr_tries it becomes in...,-iiio a'1(-.1 the ov..ner must our/an a se...
ATTENTION: MOVER, HAULER,OR TOWER
A Parsor",%h0 Is engaged to rool,e a mGhtle home ll'tly rr',:prZ,'..'•:e.tr1.-1?5E.-',re;.nless toe.c...,%9,31-pr.E,,snts lwr.-.',.ilr a permit,to rnc.:4 e, toe r-in12;le hoc a a;lci
She carrot!si dater!not more than n-net/ (911i)clays before the,:lati.:of tne prcipsed move Tra ma..er sra'l visibly display the permit...,h:le the rr.o.r),le,home
S In:ra-vs t The r-,(;,e: m .st re:.,r-ti hie pe:tml to the c.,,..-,...-o'tce rt',.. kt, ,.-?re ,.t•en ttle rrt.-...e is r;Dmplete.-.1 IC 6-1 1-7-11
. .
:-'"*..:n-.:',',!,;-..-
( )
(--'\ .
SECTION A- MOVING PERMIT
. . . • , ,... ._... ....... _ _ _.... . .
• •
:3'r- q'::.?:'-c..--, * D V.e:',..?,-,-' 1,:',..? ? •?-':, ?; 1?,- --?'!--?;.-,.r-•- '
,,. .'
• ,
j. ::.: .., -. • ..
%_. %, ,' *-: i,
" ***... *.
s. ...AA .... .,
-
. /
_ . . _ . .
-•-..
,
-. , , - ' - .
vtiOk