Homestead_Davidson (5) n4, CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD I SUPPLEMENTAL DEDUCTION
FORM
I State Form 5473(R18/1-20) HC10 2020
;.--/ 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 lC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) John Davidson certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property uadee co tract-for_which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, oC ^p'Z{.a(7 _(date of signature I(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.
❑ Am(are) the shareholder, partner, or member of the entity that owns the property.
CONTRACT RECORDED
If buying on contract,Fee Simple owner's name 7
Recorder's office where contract is recorded Recorcn rn Pa.
Le
a•28
PROPERTY DESCRIPTION
County Township, Taxing district(city,town,towns 4..O Wl r '
�I
Gibson Washington Gibson,Washington COli •i
Parcel number Legal description Is the property in question: . Tr i,
26-02-47-003-000.137-017 PT LOC 3 1-10 1 AC 2 Real property ❑ Annually asses sdvwbomtee(lC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the ussee,3nd portion
of the property utilized to produce income.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
Indiana, Gibson,Washington ❑ Yes m No
:--Signs e•of.claiman"C
I hereby certify the above statements are true,correct,and complete. ,11141-
Address of contact(number and street,city,state,and ZIP code) dress of vacated homes ad,if any(number and street,city,state,and ZIP code)
9358 N.Salem Lane, Hazleton, IN 47640
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON- ESIDENTIAL
VAL
Land not exceeding one(1)acre immediately fill
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)
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 as ssed value of the mobile home or manufactured home.
Sig lure of Auditor Date signed(month,day,year)
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpaye
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