Homestead_Davis . -=' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a . ,� 7s, STANDARD/SUPPLEMENTAL DEDUCTION FORM ��r.
, _ State Form 5473(R19/1.23) HC10 ar .► —.
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) • tiaJ '1/(5 certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the followi9g despribed real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed, "t!/'t I'/2..o -5 (date of signature).I(We):
L•Er7n. DAm(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 or,rpy the property under the terms of a quailed 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
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
C2gnty Township Taxing District(city,town,townshi
.-tb OF\. Q :�{y tt ..
Pa cet Number Legal Description Is the pro in qu on:
eat Property 0 Annually Assessed Mobile Home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that Immediately nuns ds that structure Is used to produce Income,describe the use and portion
of the property utilized to produce income.
. ..0'-`{ -•••12 „AAnD - W . e iI 01
•
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township is Claimant Vacating aome H ead?
,,i
Yes o s.
Sfgnatur f I t ei Q
::f:c:z:::::;ct
ments are true,correctcromplete.eet city,state,and ZIP e) A res of Vacated Homestead.If any number and street,city,state,and ,% (]
�..1 C Six) Ai =„a,,- )n— fib ttcf "' a
. N_
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL WO HE N
Land Not Exceeding One(1)Acre Immediately (1) 2
Surrounding Residential Improvement
Other Land (2) '* ': O
tY U
Total Land(line 1 plus line 2) (3) f"�4ca-,r,,,- Z
Residential Improvements or Dwelling (4) CD
Annually Assessed Mobile/ 3
Manufactured Home Garage (5) p a`
Other improvements (6)
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Date Signed(date,month.year)
I hereby certify the above is true,correct,and complete. //�.//
Verifying Action-Signature of Auditor „ ) ��"' it. Date Si ed(d,to, onfhyear)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home that $ tjt�
is not assessed as real property or to a manufactured home that is not assessed as real properly may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Sfgnatur of luditor i fit) � * Datena (moo ,year)• f)
e414,
DISTRIBUTION:Original-County Auditor,File-Stamped Copy=yer
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