Homestead_Crisp t CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR .
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III \ STANDARD/SUPPLEMENTAL DEDUCTION
HC10 o��{ - IIIIII)��))) �—
\ �/ State Form yth(R1p/t-23) 1/ Z��•/ PrescribedbytheDepanmert of Lccal Gevemment FinaeceI, J
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) Jinn; er r l5� certify trial I(we)occupied as my;our)principal place of
residence or am(are)buying the following des bed real property under contract for which a Homestead Property Tax Standard Deduction's hereby clamed on the
date application is signed. k/Q FAN (date of signature) I(Wei
Own ❑Am tare!ouy'ng under recorded contract
0 Am(are)entitled to occupy as a tenant-stoci holder of a cooperative housing corporation
0 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
CONTRACT RECORDED
If Buying on Contract.Fee Simple Owner's Name
Recorders Office Where Contract Is Recorded I Record Number Page
PROPERTY DESCRIPTION
County Township -axing Distnct(city town.township)
G `
% r"Sdh (L),,ton
Parcel Number Legal Descnption 're property in question
1918-x- 3co COD, Ies8 O I Real Property 0 Annually Assessed Mobile Home(IC fit 1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immed.ateiy surrounds that structure is used to produce income describe the use and portion
of the property ut'laed to produce income
I �
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township is Claimant Vacating a Homestead',
ID Yes Nc
nt
I hereby certify the above statements are true correct.and complete
Address of Contact inumber and street city stare and Z;P`ode) r-cdress '!a a Hom .acidt d an u er n s reef city state and ZIP code;
935P S i kl I we" YAke 1-7
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2) 1II_J11
..___
Total Land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
Annually Assessed Mobile) — ' -- JAN 2 3 2024
Manufactured Home Garage I(5)
(9/
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) SI k'2ece44C[-C a i'+'.ram)
- GIBSON COUNTY AUDITOR
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor T Date Signed(date month yea'
1I I hereby certify the above is true,correct,and complete. I
Verifying Action-Signature of Auditor 'Date Signed(date month year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 6C •-.- -i• ' --- - -- .43 00C
Notwithstanding any other provision.the sum of the deductions provided in IC 6-1 1-12 to a mobile home that
S
is not assessed as real property or to a manufactured home that's not assessed as real property may rot
exceed one-half(1/2)of the assessed value of the moode home or manufactured home
Signature o ofUL Jr/�jA({
of AAAuudittor / Date Signed(month day year)
-- --- 1./ --------L---—112.3 t?ii-----------
DISTRIBUTION, Original-County Auditor File-Stamped Copy-Taxpayer
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