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Q.
_ . CLAIM FOR HOMESTEAD PROPERTY TAXYEAR
\4d1 STANDARD/SUPPLEMENTAL DEDUCTION �Rp 2o2a Pay 2ozs
1 P atees ribed 547byth(Dep/1-23)
[,I1yW_ x`\ Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
I OTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
l9is CERTIFICATION STATEMENT
DI(We) Mickey Lee Scott certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the fql{owing desc beproperty under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
date this application is signed,/(• ' (date o/signature).1(We):
0 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.
Cc
A ' CONTRACT RECORDED
��11 /�` If Buying on Contract,Fee Simple Owner's Name
iM NiA
fiLO
LAVA 1/4/S011 Recordels Office Where Contract is Recorded Record Number Page
e-
`O PROPERTY DESCRIPTION
County Township Taxing District(city,town,township)
Gibson Montgomery
Parcel Number Legal Description he property in question:
26-17-21-200-004.431-021 pi,)
Real Property ❑Annually Assessed Mo Horn i
D
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use andI
of the property utilized to produce income.
APR 2 2 ?024
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homastead7 �/)y- ' ' •
Dye - ❑y AU No C)ITO/i.
Signature lanm
I hereby certify the above statements are true,correct,and complete. .
Address of Contact(number and street,city,state,and ZIP code) Address of Vacted Ho ead,if any(number and street,city,state,and ZIP code)
7887 S 950 W,Owensville,IN 47665
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3)
Residential Improvements or I Dwelling (4)
.s:muairy isaassau iriooi.0 I
Manufactured Home Garage (5)
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 Date Signed(date,month,year)
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 $
is not assessed as real property or to a manufactured home that is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor /� ` Date Signed(month,day,year) -
,Ii--v_t_piL4,
DISTRIBUTION: Onginal-County Auditor,File-Stamped Copy-Taxpayer
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