Homestead_Davis�'"' CLAIM FOR HOMESTEAD PROPERTY TAX
�._. ; STANDARD/SUPPLEMENTAL DEDUCTION
Stata Form 5473 (R12 / 6-09)
�a � PresvibeU by Ihe Department af Laral Govemment Frience
�� �
! i- i
� �. f' � }
� '
INSTRUCTIONS: Seeleverse side lorfiling insUUCfions. � � ���
. .
1(We) � Q) certiry Nat I(we) ocwpied as my (our) prindpaieF
place of residence or am (are) buying Ihe foliowing described real property for which a Homeslead Property Tax Standard Dedudion is hereby daimed
un er conVad on �he date this application is filed, (date of filing):
I(We) own ❑ Am (are) buying under recorded conVact
Am (are) entitled to oceupy as a tenant-stockholder o( a woperelive housing corpora6on
� Have a beneFicial interest in the Wst or the right to occupy the property under ihe terms o( a qualified personal residence Wst
•• . •
II buying am m�treq, Fee Simple awnefs name
Remrdefs otfice where mntrap is remfdeE Record number Page
. _ � . _ � . �
�nry Trnunship Tari di '(ri7y, to , towruhiA)
Parcd number d 'ptim � _�� Is �he p perry in qursiian:
Real prope.rty ❑ MnuaOy assessed rtn6ile Inme (IC 6f.1-7)
�It any portbn ol Ne residenllal sWC¢ue or the IaM not exceeding me (1) a�re that immeCiatety wrtau as at swcNre is used to p�oduce inmrie, aesrti0e the use aM portion
of Ne property urif¢ed to P�oduce i�ome. �
a� - �4-��- �� �- 6O 'I. .3s y=_ �a�
-.. . . _ . .
Coumy Township Counry Towral6p
i hereby ceNfy the above sfatemenu are we, cortect and complete. 5ignywre or aaimant -
�� � ��
Pddrew (numbe� ard street, ary, sfate, aM LP �)
l4 F r c-+ l3m,�; '-171�`i 8
�_ � � . •� . �
�� .. �
Land not exceeding 1(one) acre immediauty � .�y�"''/�n��,`, ,�'T�l,�'41��'� �r�„y.�u
surtoundin residential im rovements. (� 5..-'-.� �?kxs'L.. -{' v'35:��:1'
Other lantl 2 � �%�='y�Y7'i"14� `="ti
( ) ., i`,:s:i Ra'rw^'� c.,
7otal land (line 1 plus line � (3)
9 ( ) t-�:i`c;� �N1x✓:��h.� �.:• ?_
ResidentlallmpravementsorMnualty �eliin 4 . £, ��«„ i.��,�,� �-„� ���.�
Assessetl Mo6ile I Manufactured Home Garage (5) s� F.iu s`T���'�r`w�� � y�� ;
! .._...£ 'l i�T.,.<-a'�` $ `G` ��.%?i' .
Other improvements • (6) � „X� q r�.:�?��7a�
7otal Improvemenb (Ilne 1 Nrough line � (7)
Total value (llne J phs Itne 7) (8)
I hereby certify ihe above is true, cortect, Sigrawra ofASSessor Date slgnad (monfh, day, ysar)
and complete.
Verilyin� acnon - Sigreture af /wdmr Date signeE (monN, day, year)
� �.-� � � • •
20 pay 20 Lesser of 60% ot the assessed value of the homestead or 545,000
AbtwiNSlaMing any olherpravision, ihe sum d fhe deductbns provided in IC 6-1.1-f 2 to e rtro6de home Naf is 5
rpf assesseE as real popeily or fo a manNacturad hwne that is not essessed es iaal pmperty may rwf erceed
one-heH (12) W Na assaued rdlue W Ne mobde hortre ormanNarluretl hortie.
Signature o( PLd1tOr Date SigneE (mOnN, day, yee�