Homestead_Davidson (6) �.�• CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
s! STANDARD/SUPPLEMENTAL DEDUCTION HFOCRM
10
State Form 5473(R18/1-20)
..'+ ••• 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
�/ ; tai'r<j�j
I(We) 1`.- � 4 i NIIIMPY' ' ' ".- yAir certify that I(we)occupied as my(our)principal
place of residence or- (are)buying the following described real property under�ontract for which a Homestead Property Tax Standard
Deduction' hereby claimed on the date this application is signed, /// 7//7...z>2 2 (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.
-
If buying on contract,Fee Simple owner's name
- Record number Page
Retarders office where contract is recorded
PROPERTY DESCRIPTION
County Township Taxin ct(it wn.township)
V
Parcel number Legal description Is the props efitLJ
/-� '/]� _o/8- 57 eel property 0 Annually assessed mobile home(IC 6-1.1-7)
�0_D� H'7l one t Op g one( that imi diately surrounds that structure is used to produce income,describe the use and portion
If any portion of the residential structure or the land not exceeding 1)acre ///
of the property utilized to produce income
PT i_it%c 3 //D 2. 3/,4-a.
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County.and Township Is claimant vacating a homestead?
❑ Yes l ''''NZi
Signature of clairfianl. V va
I hereby certify the above statements are true,correct,and complete. a,Y(OJ,-j,0,-j J
Address of contact(number and street,city state,an IP code) // Address of ated homestead,if any(number and street.city,state,and ZIP yodel
93zo �'� yam(/C�K T=� .J /zozl
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
Landrrnotning re ide one )acre immediately (1) --- A tr
La n ex residential nl improvementscrimmediately
- I (/^�\ O
Other land (2) - — -- _ 0
N I�
Total land(line 1 plus line 2) (3) N `' Q
O _\\
ni 1 Y
Residential improvements or Dwelling (4)
annually assessed mobile/ I Garage (5) I—
n
manufactured home
•
Other improvements (6) LJ '
�1 Q . O
Total improvements(line 4 through line 6) (7) CD Z
O
Total value (line 3 plus line 7) (5) _ - - 0
cfp
Signature of Assessor Date signed(month,day yeaA m
I hereby certify the above is true,correct. O
and complete. --. --- - - Date signe (month.-ay,year
Verifying action-Signature of Aud'- // 7 �r�2—7
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 lC 6-1.1-12 to a mobile home $
home that is not assessed as real
that is not
one-half(1/2)of as realproperty
assessed value of theor to a umobil home or manufactured home. property may
//ditor �� Date sign (mon ,day,yeah
Signature of Au// /K; ,—Gl�, lI / 7 7._o2 2_--
DISTRIBUTION:
Original-County Auditor,File-Stamped Copy-T
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