Homestead_Davis (25) .e-co CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
...` a� STANDARD/SUPPLEMENTAL DEDUCTION FORM
\ 3' State Form 5473(R18/1-20) HC1 0
Prescribed by the Department of Local Government Finance -
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential unde -
CERTIFICATION STATEMENT
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I(We) certify that I(we)occ ed.A i(sue). y. e_ r
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date ofsignfl JJ )fN :2020
❑ Own. ❑ Am(are)buying under recorded contract. ��VV
❑ 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 perso residen tru
❑ Am(are)the shareholder, partner, or member of the entity that owns the property.
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Social Security number of claimant's spouse(last five digits) Driver's license I Identification/Other number of claimant's spouse(last five digits) Issuing State
(Applicable only if applicant's spouse does not have a social security number.)
CONTRACT RECORDED
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing s nct(city,town,township)
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Parcel number Lega escription /-IIss the property in question:
y'❑Real property ❑Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding on 1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant v ing a homestead?
• ❑ Yes No
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city state,and ZIP code) Address of vacated homestead,if any(number and street,city,state,and ZIP code)
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately
surrounding residential improvements (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other improvements (6)
Total improvements(line 4 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.
Verifying 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(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor Date signed(month,day,year)
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DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpayer
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