Homestead_Hunter (3) 'a� CLAIM FOR HOMESTEAD PROPERTY TAX '1 YEAR
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FORM
,d•, � STANDARD 1 SUPPLEMENTAL DEDUCTION Hc10
: ist 3 R'State corm 54 e,1-J
n•/ F-escnbed oy me Cepartme-t o'Loss 3o:e:r-re-t=^.a-s...
INSTRUCTIONS See reverse side for filing Instructions
NOTE Telephone,Social Secunty.drivers license state identification and federa,ioentifcation numbers are confidential under IC 6-1 1-12-37.
//i� Ill � . 1 CERTIFICATION^ STATEMENT �l 11
;We t.GY'\CIL_ "�` _ten the tn I Ian x' cuped as my'our'pnncipa s place of \
res de ce or ar-;are;b.y;g tie f v.n^disc-ceo rea proce'y goer oo.t a to:ar Cr a Homestead Property Tar'Standard Ded t cos hereby:fa e__ ' (1!,�
date,!Fts app:ca:,cr s s goes -kQ r 7 L. (date of 5 g 5.Jre) I Y.e '� .
t[ ' r,,- 0 k' ate C..y.rg,,.rder recareed o otra t n f�
ElAT eotted to occupy as a ten s ocihc'de o a cat oe atve he s c__ ..c•a',- ,-�J /"�. ^1
❑Have a ceref c a ntere5t m the trust or t�e".gh..o Occupy t e p--ert. .-. - _a _o ce'so a '_ __-'_e!--s: <LLJJJ111 IV l�
❑Am(are i the shareholder,partner or member of the ent.ty that o:. - - -,
CONTRACT RECORDED •
14 Buy'rg on Contact Fee Simple Owners Name
Reoorders Once Ace•e Ccrtract s Recorded ;Reco'd'umber i Rage- \ _
0
PROPERTY DESCRIPTION
County Towns5,p Tat.-;- O.
C'- cr . I
-mil 4(0 lW.s
cs•ce:N.L,mces Lepal Jeserpt t s the:cpe.^.y ^c.e ..,r
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- .ea.pscpery ❑'-_ay Assessed/cone=die C_
it any co cn cf toe•esde^ta s _ e :•_ : .. '^--ore'1 a-re ."^Ted s'e _:- do t^at st-Jct•..re s..sed to crc0Jce-come describe the use and pod_ 0
of the P ore"y ut zed to prune O
1
a U2 Vat'.0 iQl ‘-Mq • S C)- 0Q-1 -
PROPERTY OWNED ELSEWHERE BY CLAIMANT (
State County and Township - �r :yam -i ' (^ \ ' -
I hereby certify the above s?a?emerls are true correct and complete \/ EcNI. vY • r^'' — (SP°1°.
d ass- arc' ^dab=e' o.. - _. a _ _.. /
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ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately
Surrounding Residential Improvement ___ •
_Other Land (2, (
. Total Land(line 1 plus line 2) 13i 1
FILED
Residential Improvements or Dwelling 4;
. Annually Assessed Mobile I _
Manufactured Home ' Garage 't5;
Other Improvements APR 19 2024
• Total Improvements(Line 4 through Line 6) c- k-'
Total Value(Line 3 plus Line 7) Sr1 a 1/� ko
s'grat'-e c'-`:e ld��jg� COUNTY AUDITOR
I hereby certify the above is true,correct,and complete
Verhy'rg Action-_.g^at.,re o'4i,d tot — :ate S.gred da-e
STANDARD DEDUCTION ALLOWANCE
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Nof.:drstanding any otner cro'son the sum of:re dedoctcrs prov'dec r'C 5-I t-•2 rc_TOC 0 c e - -
' 's not assessed as realpropert/or to a tra^ufactured tome that s not assessed as-ea p oce'y-;ay-o!
exceed one-hail;t,2;of the assessed vase of toe moo'e rcme or manufactured acme
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Sidnat-re cf P:d,CJs a'- . _. _ - Date Signed',worm +ay
4_ 11:1._ yma
DISTRiBUTI N :r;rat,-Corr r -- -• _ S'amced= --a.caye•
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