Mobile Home_Jackson •
4, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4-, ,I,, .. :,,4/I • ' V STANDARD/SUPPLEMENTAL DEDUCTION FORM
HC10
ll..MIJIY___W Stale Form 5473 1R19/1-23) .
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 1C 6-1.1-12-37.
CERTIFICATION STATEMENT
(
I(We) 101411711111ra P 1 tIL *143 • certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the follp ing described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
at application is signed, \I
Own. (date of signature).I(We):
0 Am(are)buying under recorded contract.
El (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
K
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
El 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 Township 017 . Taxing Districf y,titownship)
Parcel Number ...)°V CI
Legal Description Is the property in questi : ..,
Jo Real Property Annually Assessed Mobile Horne(IC6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to rod ce income,describe the use and portion
of the property utilized to produce income.
4 DAf2'"' Lk'- tri '43 516-U-
00
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacati g mestead7
Dyes No
Si nature of Claimant Il
I hereby certify the above statements are true,correct,and complete.
-.....,_
Add doMmber an.isA eel,city,slate,and ZIr ild:) Address of Vacated Flo tea ,it a y urn er and street.city.state and ZIP code)
I\1 A A -af 'III
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One 'I-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!
a z.
Manufactured Home Garage (5)
Other Improvements (6)
C C2
Total Improvements(Line 4 through Line 6) (7)
it'lIZ -,
Total Value(Line 3 plus Line 7) (5) 400 •
Signature of Assessor .649.- ed(date,month,year)
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 6016 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 th. ' of assessed as real property may not
, exceed one-half(1/2)of the assessed value of the mobile h•
• -.•ufactured home.
Signature of Auditor 14,13 cdt.. ._zs1/4, Date Signed(rIanIh da,year)
11 C r2/°2LI 1
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
Page 1 of 2
e a
MANUFACTURED (MOBILE) HOME PERMIT -
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ATTENTION MOVER, HAULER OR TOWER
/ • - SECTION A MOVING PERMIT
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..... •• : . • .. •
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Name of Dealership
/ - -
- - - --- - - - - -- - - - Address
.ature _
-____ .. _ . _ __ _. _. . _ -..__. ..__ .... _ _ ._ .__ ._.. City 'State Zip Code
Printed Name I __ ___ _ _
'1 AM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SELLER(5)
Position - - - - -`Dealer Number Signature of Purchaser !Printed Name of Purchaser
Date of Sale immt.day.year)
SECOND RE-ASSIGNMENT BY REGISTERED DEALER ONLY
I/we,as Seller,certify that to the best of my/our -____. Name of Purchaser 'Dealer Number
knowledge the information contained on this document L-[j r I-� _ I
is true and correct and that the odometer now reads Address
and is the ACTUAL MILEAGE of the vehicle unless one
of the following statements is checked. - -- - -- -
The odometer reading is not actual City State 'Zip Code
[J The odometer reading stared is in excess of its LI mileage 1I
mechanical limits. WARNING ODOMETER DISCREPANCY. - ---
Name of Dealership Holder of lien,mortgage or encumbrance(if applicable)
. - _ Address
Signature
City State 'Zip Code
Printed Name
- ------------- ---- ---
____.__. .._...-.____.._.__. ___......__.._..._ ..-_ -.._ ,_.___.-_..._._.__.___.____ IAM AWARE OF THE ABOVE ODOMETER CERTIFICATION MADE BY THE SEU.ER(5)
Position Dealer Number Signature of Purchaser - -- Printed Name of Purchaser
Date of Sale lieu n,day,year)
THIRD RE-ASSIGNMENT BY REGISTERED DEALER ONLY
l/we,as Seller,certify that to the best of my/our _r Name of Purchaser 'Dealer Number
knowledge the information contained on this document _1 L_1 L I ,l-I L- - - - - -- - - -`
is true and correct and that the odometer now reads Address
. and is the ACTUAL MILEAGE of the vehide unless one
of the following statements is checked. - --'
The odometer reading is not actual City State - Zip Code
The odometer reading stated is in excess of its
'-� _
C� mileage
mechanics!limits. L-i WARNING ODOMETER DISCREPANCY. - -
-_-_ _—_ Holder of lien,mortgage or encumbrance(if applicable) ---
ie of Dealership
---- ------- -- -- Address
Signature _
--__- --.- -. City State Zip Code
Printed Name
_ _ _ _ ___ I AM AWARE OF THE ABOVE ODOMETER.CERTIFICATION MADE BY THE SELLER(S) _
Position Dealer Number Signature of Purchaser Printed Name of Purchaser
_
Date of Sale teentn,day,year)