Homestead_Davis CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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STANDARD/SUPPLEMENTAL DEDUCTION FORM
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is State Form 5473(R13/12-09) BM
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing insbucrions.
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I(We) Ali.�/ - • certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property for which a Homestead Property Tax Stand is under her Dd uer contract on the date this application is filed, (date of filing). I(We):
INI Own El Am(are)buying under recorded contract I
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation A 8 El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residences tRs2 20 14
❑ Am (are)the shareholder, partner or member of the entity that owns the property.
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atr ��rh' ^.=r�'3:•,. CLAIMANTS INFORMATIONF '� �r...cafi �. Y.a:..c9' a.
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If buying on contract Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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��^'2" %- `�.° -"iy ia�,�9 w r_ "5 - PROP,ERT;V�DESCRIP,TION - ��t.:rsdn., �fu.._},.:ra.:3�A{�z i�i� 1`.:'.Y
County Township Taxing district(city,town, wn
Ca-710
Parcel number L I d n Is the property in question:
ew/(7�a�`tto //_ Real property ❑ Annually assessed mobile home(IC 61.1-7)
If any portion of the residential structure or the not exceeding one(I)ac is surrounds structure is used to produce'income,describe the use and portion
of the property utilized to produce Income.
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.Ric .YT } PROP,ERliWg:1E B.Y7TAIMAhY^T'IN'QTHERKCOUNTIE411WintigwSJ2`fS?t°,g li "yV111,-:it ;;
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of claimant
Address(number and,street,city,state,and code) : j�jj'' / 7
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R -;o•T`--"f C"r. ?t .i..n...�rltr'$ r`' ,,r' oid ir- SESSED VAI:UE'ierii5MESTEADT`q Y atNON RESIDENTIArriti c.
Ln+-'CF '<< ASSESSOR USE,ONLY �i` ;; "L �gTRUEkTAx sVALUE if ATM1100%?OFFTTT,MA4Pi ridVALUE> r ` v s'``r i-AWALUE en.n-.s`'s-4
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Land not exceeding l (one)acre Immediately (1) � .-'
Qr. ; _a=a
surrounding residential Improvements. -
Other land (2) .4,,,,
Total land(line 1 plus line 2) (3)
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Dwelling (4) `' mrr
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Residential Improvements or Annually _
Assessed Mobile/Manufactured Home Garage (5) v -`` : ,•y..s
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Other Improvements (6) r-., _ zt.a
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is we,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
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}.<w-?.�.�s�>.i1�.e„�',3na•'t�Lti�a i<3 "�:31r..ew .��._. �T�. v 'S�£`aN;+rS�".1c....,..�?ti+•h ,:�.n.,....._.._ .a1:t�-a°.�`.'�
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 61.1-12 to a mobile home that is $
not assessed as reel property or to a manufactured home that is not assessed as real property may not exceed
one-hall(12)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year) -