Mobile Home_Gaines CLAIM FOR HOMESTEAD PROPERTY TAXI YEAR
At" STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5473(RI 8/1-20) FICUI
Prescribed by the Department of Local Government Finance '
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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
IA cA.m
I(We) 1 \jk ot0L-A-At0.A. v e . certify that I(we)occupied as my(our)principal
place of re idence or arr4re)buying b e following descriXdfreal property under contract for which a Homestead Property Tax Standard
Deduction is hereby claim d on the date this application is signed,8/— (5—)4 , i:
IOwn. D Am(are)buying under recorded contract.
E m (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. _(date of signature). I(We):
'r0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
zi,,,
CONTRACT RECORDED r
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
• PROPERTY DESCRIPTION
County Township
0 2-1 Taxing district(city.town.township)
Parcel numb
Legal description R) frtA.A
i Is the property' qu tion. ...,...._
: Annua y assefssed mobile home(IC 6-1 1-7)
D Real property
If any portion Of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is use o pro cc income describe the use and portion
of the property utilized to produce income
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township lie c im nt vacating a homestead?
Yes 0 No
i I Siiig 17-7ci.f cr'',risa.Taiman - i j
I hereby certify the above statements are true,correct,and complete. ill atet. „ ,
/
_ ..
Address of contact(number and street.city state,and ZIP code) i
...--;"' Address of vacated homestead,if any(number and street,city.state,and ZIP code)
000 $1 \\ - ---L14“ 1 lb 6 ct tO 0 1.A_Do"YI-4._ i\ btivv-A13
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
4 4
VALUE 4, .1, •
Land not exceeding one(1)acre immediately
CI)
surrounding residential improvements •*. ,....it ,re.,-..: '..s.--.4:1)..vri-or'.,....4;it:
Other land I(2)
..-,f;. fie .i' et---...'•-rv,-.1--i.4,1
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) 'al.g.•:-; .. "4%1 -: •;-i__-:
annually assessed mobile I
manufactured home Garage (5)
'lig"".7 P•;f:',...f kla.i.;:0,re,..47140;
Other improvements (6)
::c:,'_,s,f1f --..,• :f:,=?-2,:Sf,ft'.
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8) i
Signature of Assessor G gs I Date signed(month day.year)
I hereby certify the above is true,correct,
and complete.
Verifying action-Signature of Auditor ‘1A/71/.ii si ned(month,day.year)
I OF?
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
minercq,ddicezlarle-haffea)of the assessed value‘11 of(m bil1horrie or manufactured home.0. siWrerofluditoranw. V cm 1
Date sig d(month,day,year)
...---"--
(0 10 L)
DISTRIBUTION: Original.County Auditor,File-Stamped C -T ayer
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