HomeMy WebLinkAboutHomestead_Davis (2)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R1216-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS., See reverse side for filing instructions.
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FOR
1g 9f1 ` YEAR
JUL 2 6 2010
I (We) q' -cerveytnaRguKetuomm (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
F�> (we) 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
INFORMATION
Name imant(legal name)
61 / C ' r-.!'
name
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Social Security number of claimant's spouse (last five digits) Drivels license I Identification
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IL
CONTRACT .•• •
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY
County
Township Taring district (city town, townsfpp)�
Parcel number
I ddesolption
Is the property in question:
L4,fteal property ❑ Annually assessed nubile tome (IC 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) ace that immediately surrounds that structure is used W produce income, describe the use and pondn
of the property utilized to produce income.
a(o- o3- Z3 -,��0 •moo• 3aS -oi8'
PROPERTY
County Township
Caunry Township
1 hereby certify the above statements are true, correct and complete.
Signature of claimant
Address (numberand street, oly, state, and ZIPcode)
ASSESSED ASSESSOR USE ONLY TRUE TAX VALUE VALUE HOMESTEAD NON-RESIDENTIA
AT 100% OF TTV VALUE VALUE
Land not exceeding 1 (one) acre immediately ,•r- =;-,
(1)
surrounding residential improvements.
Otherland
(2)r?`'
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-Y
Total land (line 1 plus line 2)
(3)
Residential Improvements or Annually
fling
(4)
Assessed Mobile I Manufactured Home
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Other improvements
(6)
'fr`.<t1txs'• "'1t
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Data signed (month, day, yeah
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or 545,000
Notwithstanding any other provision, the sum of the deductions provided in IC 6-1.1 -12 to a mobile home that is
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not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
one -hat (1R) of the assessed mtue of the mobile home or manufactured home.
Signature of Auditor
Date signed (month, day, year)