Homestead_Davis (4) I . I
Zti"o CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
k__. = -STANDARD /SUPPLEMENTAL DEDUCTION FORM State Fonn 5473(R13/12-09)
.,�, Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. ' / }— Li 3 o - 13 I
•
CERTIFICATION STATEMENT
I(We) a' Qr fyy ,� s my .principal
���i' z _0 -I a- L • certi tha we occupied as m our
place of residen 1 or am(are)buying the following described real property for which a Homestead Property Tax Standal4,Llpdyptidn is hereby claimed
under contract on the date this application is filed, (date of filing). I(We): 1.. �I LL . J
❑ Own ❑ Am(are)buying under recorded contract n,
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation ,T/�/L`
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified pIO t iSOMiErldf410VAf AUDITOR
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
- ,`' .
, .. _ . < -
If buying on contract,Fee Simple owner's name
I Recorders office where contract is recorded Record number I Page
il
- .._ -4.;PROP,ERTY,DESCRIPTION - •--
County Township T " g district(city,town,to ship) . . . _
Parcel number Legal description • I Is the property in question: I
)(a / 74C( nQ ill Real property El Annually assessed mobile home(IC 6-1.f-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately s unds that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
ae _ /g- 340 - 3oo _ ooa . 5s0 -o 4
�. N
- - -- • - pROPERT'iOWNED BY CLAIMANT IN OTHER.COUNTIES. ,
County I Township County Township ..
I hereby certify the above statements are true,correct and complete. a ant `
,,I/j1 Address(number and street,city,state,and ZIP code) 1
ASSESSOR USE ONLY • I-
TAX VVALUE d AAT-100/o OF rn I H I NON- VALUE
Land not exceeding 1 (one)acre immediately
surrounding residential improvements. (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Dwelling (4)
Residential improvements or Annually
Assessed Mobile/Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 0 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Vaifying 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$45,000
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(12)of the assessed value of the mobile home or manufactured home.
Signature of Date signed(month,day,year)