Homestead_Wagner (3) r.. CLAIM FOR HOMESTEAD PROPERTY TAX I FORM I I YEAR
401.,'' STANDARD/ SUPPLEMENTAL DEDUCTION OR ''_� („�
Stale Form (Rip/1-20)
Prescribed byy the Department M 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)
Joshua D./Kaylei gh P Wagner certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under/02/2021for which a Homestead
of signature). `W Tax Standard
Deduction is hereby claimed on the date this application is signed,
IliZ Own. ❑ Am(are)buying under recorded contract.
❑ Am(are)entitled to occupy as a tenant-stockholder of a coopperattiverthoy using
nder corheporation.
s of a qualified personal residence trust.
❑ Have
b hefisial interestholr in the partner,orust omember right
oft the ent occupy
iity that owns the property.
❑ Am(are)the shareholder. p
CLAIMANT S INFORMATION
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
Record number Page
Recorders office where contract is recorded
PROPERTY]E SCRIPT ION
County
Township Taxing district(city,town,township)
Gibson Montgomery Montgomery
Legal description Is the property in question:
26el y17-32o300-005.628-021
P2 number I Real property ❑ Annually assessed mobile horns(IC 6-t.1-7)
the portion
on of the residential structure the land not exceeding one(t)acre that immediately Q surrounds that structure is used to Produce income,describe the use and portion
of the property utilized to produce income. —\ _ 3 �-�3O O -ons- 62 3 -Q21 ,
PROPERTY OWNED ELSEWHERE BY CLAIMANT Is claimant vacating a homestead?
State,County,and Township Q Yes 0 No
I hereby certify the above statements are true,correct,and complete.
Address of contact(number and street,city,state.and ZIP Code)
Address of vacated homestead.if any(number and street,city,sate,and ZIP Code)
10183 S Koch Dr,Poseyville,IN 47633 ASSESSOR USE ONLY
ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
'ilft
Ldooiengdinnoaemovmdiately (t) e TP-Sry4 „
A F?".
-�
Other land (2) ii 4,..•i:.!AVI 7ir ,
Total land(line 1 plus line 2) (3) £a'R `g
: =ter
Residential as improvements or Dwelling (4) �, t
annually assessed mobile I Garage (5) '� ti'e,t* i ':'"' _ _,_-. -i
manufactured home ,', 1�';:u,Y .',
(6) .,. -
Other Improvements
Total improvements(line 4 through line 6) (7)
Total value (/Ine 3 plus line 7) (5) Date signed(month,day.rear)
Signature of Assessor
1 hereby certify the above is true,correct,
and complete. Date signed(month,day,year) 1
Verifying action•Signature of Auditor
STANDARD DEDUCTION ALLOWANCE ,/)_ 020, pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. �UV
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ �
( _ e
Mat is not assessed as real property or to a manufactured h e ' not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mob e home r enufaclured home. f Date sign dad year)
G
Signature of Auditor I/v tf` I 2 2.‘ _ <(-
DISTRIBUTION: Original-County Auditor,File-Stamped Copy-Taxpa yam'/>
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