Mobile Home_Davis (2) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
'�-�! STANDARD I SUPPLEMENTAL DEDUCTION
ss� State Form 5473(R1711-16) HC 10
„ Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for Ming instructions.
NOTE:Telephone,Social Secunty,driver's license,state idenb.Xation and federal idenuficaron numbers are confidential under IC 6-1.1-12-37.
I(We) Ronald Cia`A, certify that I(we)occu a ur ci I
place of residence or am(are)buying the following described real properly under contract for which a Homestea Property Tax Standard
Deduction is hereby claimed on the date this application is signed, 501/15 (date of signature). I(We):
M Own. ❑ Mn(are)buying under recorded contract.
MAY 31 2019
❑ 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 person- -sidence st
❑ Am(are) the shareholder, partner,or member of the entity that owns the property. Id, — ./,1
L. - .. .CLAIMANT'S INFORMATION.`..- , -. [:; :• , DITOR
Name of claimant(legal name) Telephone number of claimant
Ronald Davis ( ( ) -
Name of clamant's spouse(Anpl name)
Social Searcy number of dam ants spouse(Iasi the acts) Onvers license I ldent cat n I Other number of tlarrants spouse(last eye dgs) Issuing State
Ropricabre onlydappicame spouse does nor have a social sewn),number)
+. -an. i_i _ :CONTRACT RECORDED. n sn =i�''
e buying on conflict.Fee Simple owners name
Recorders sere where contra is recorded Record number Page
"t t ,;''. .•— ... PROPERTY DESCRIPTION��.... A. •__ 1 �.
County Tovmsnip Taxing darned(oty,town,township)
Gibson Patoka Princeton
Parcel number Legal desmp:ion Is the propetty+w guesl0n:
26-428-05134-00 ❑Real property 0 Annually assessed'noble home(IC let r-7)
u any ponim of the resolenbal structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce itmme,describe the use and potion
of the property utilized to produce income.
- -` v'+ ' + PROPERTY OWNED ELSEWHEREBYCLAIMANT ,(s�' ' ' :•3'
State,county,and Township Is claimant vacating a homestead?
0 Yes 0 No
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street cry,rare,and ZIP Code) Address of vacated homestead,if any(number end sve. see.state,and ZIP code)
308 S Ash St, Princeton, IN 47670
ASSESSOR USE ONLY,'" _• . ASSESSED VALUE tHOMESTEAD VALUE'Q. I ` 'NON:RESIDENTIAL .
Land not exceeding one(I)acre Immediately I(1) N
surrounding residential improvements - -
Other land (2) _
Total land(line 1 plus line 2) (3)
Residential improvements or ' Dwening (4)
annually assessed mobile I manufactured home Garage (5) -
Other improvements (6)
TOW improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (B)
I hereby certify the above is true,comet,
of Assessor Date signed(.morn,dry year)
and complete.
Ve'ty g action-Signature of Auddor n Date signed(crouch,day,year)
ru�� a. 05 3/19
• . . STANDARD DEDUCTION ALLOWANCE d-` . • .. . . . '
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45.000.
Notwithstanding any otherpmvison,the sum of the deductions provided in IC 6-1,1-12 to a mobile home 6
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 monde home or manufactured home.
signature of PudlUr Date signed(month.day year)
Oth tr-.g,`4. 05/31/2019
DISTRIBUTION:Onginal-County Audstor,File-Stamped Copy-Taxpayer
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