Homestead_Davidson •
0•^•4,, • CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
�� )' State Form 5473(R18/1-20) HC10
2020
'° ,®ri, 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 under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) Jay&Julia Davidson certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property ontract-for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed,, ._— (date of signature).I(We):
121 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.
❑ Am (are)the shareholder, partner, or member of the entity that owns the property.
If buying on contract,Fee Simple owner's name =
s
,f
Recorder's office where contract is recorded Record numb age
d
PROPERTY DESCRIPTION
County 'Township Taxing district(city,town,township)
Gibson Washington Gibson,Washinft
Parcel number Legal description Is the property in dtfl(j./�/ , ®so
26-02-24-400-003.066-017 PT SE FR 24 1 10 1.63 AC WI Real property k2 f$3 ssed mobile home(IC-
6-i.1..7)
If any portion of the residential structure-or the land not exceeding one(1)acre that immediately surrounds that structure is used to prrodCCu..11/' ekrn the use and portion
of the property utilized to produce income.
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PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Indiana, Gibson,n Washington EziYes ❑ No
Signa a of claimant-—;
I hereby certify the above statements are true,correct,and complete. � J /
Address of contact(number and street,city,state,and ZIP code) A r s of v ted homestead,if any(number and street,city,state,and ZIP code)
9369 N Salem Lane, Hazleton, IN 47640 9358 N. Salem Lane, Hazleton, IN 47640
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements
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) 1
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 ass ssed value of the mobile home or manufactured home.
Sig lure of Auditor Date signed(month,moth .
day,yeeaar)^,may/�/—�)
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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