Mobile Home_West ..rv.--.. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR 1 •
l s*s. STANDARD!SUPPLEMENTAL DEDUCTION FORM y
R State Form 5473(R181 1-20) HC10 'Z)
.!;,, '"'' 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) 411, t lei
e ne,R-i- certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
i"i Own. ❑ Am(are)buying under recorded contract. .
■ 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.
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County 1 Township Taxing district(city,town,township)
Son Q 2
Parcel number Legal description I Is the property in question
, ❑Real property r• Annually assessed mobile horns(IC 6-1 i-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to pr uce income,describe the use and portion
of the property utilized la produce income
26 ,L\2_S , 0.c'-263 - o0.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Stale,County.and Township Is claimant va a' g a homestead?
All' ❑ Yes No
I Signature��j j ,
I hereby certify the above statements are true,correct,and complete.
i j
t.
Address of contact(number and street,city,state.and ZIP code) Address of Y.ted homestea..if any(number and street,city.state.and ZIP code)
500 W U3CutnO ck St t CTV C L-1 1 )i'°4/.-L04,9
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
t
Land not exceeding one(1)acre immediately {1} -tr iia r^rW�y3'v y .
surrounding residential improvements .,gym.,ti..al,:.',ib
Other land (2) ''r ` $0 fg,,A :
I Total land(line 1 plus line 2) - . (3)
P g lf+ ' 4
Residential improvements or Dwelling (4) ,%x'r iwi r -
ati
annually assessed mobile/ a
manufactured home Garage (5) 7yf
Other improvements (6} f, fi F ,, a e !p
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor I Date signed(month.day year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day.year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
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 mobile home or manufactured home.
Signature of Auditor
Vt`A^jk C r/J } Date signed(month.day.year)
I
DISTRIBUTION:Ongipal-County Auditor,Fite-Stamped Copy-Taxpayer
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