Homestead_McClain '' .. , CLAIM FOR HOMESTEAD PROPERTY TAX FORM i YEAR
;^ STANDARD/SUPPLEMENTAL DEDUCTION HCR 20 YE
• State Farm 5173 Olt 911-2]) _- 24
_-J
•� .resc*xd ay me Depart-iv-it.1.aea C:ve^-e••;°^arse
INSTquCTIONS See reverse side for filing!nsrrucbons
NOTE Telephone Soaat Security driver s'Tense state identification and federal idenlrficatron numbers are confidential under IC 64_1-12-37.
CERTIFICATION STATEMENT
l Wet 'icier-_ . / •r , r ._.„4,4••! certify that I(we)occupied as my(our)orindpal place of
•es,der•ce or am(aro)busing:re fo:cw r'g user be*•eal ercoerty under contract(or which a Homestead Property Tax Standard Deduction is hereby claimed on the
dale Ina eDel.catnon is signet 4142024 (date of signature)I(We).
DOA-. CI Am;are`paying under recorded contract
❑Am tare)entitled to occupy as a than:-stcc0 c aer of a cooperative rousing corporation
0 Ha'.e a Deret;a -R•es:n:'re:•ems:or:^e•g^:to occupy trio oroceny under the terms of a qualified personal residence trust
❑Am tare nre sna•endiaer partner o•member of inc entity trial owns the property.
CONTRACT RECORDED
f 3-y.ng o^Ce^rac 'ec 5,rio'e Ow-era Same
O
4^ry F-
aecamers Woe Veee;,antract sReri^:e4 Record Number !Pae N E3
o a
PROPERTY DESCRIPTION ct'
-aw• r s Tarare Disct(city.fa ,tewnsf;pl O �s
s Z
'GIBSON ;UNION ' m fawn,,
TOWNSHIP 2 a 0
°arce\:.,,per .ga Cesc-m:en Is the properly m quest, )....M.1 Q U
126-18-26-300-002 364-025 PT SW 26 3 11 2.64 AC Cl Reale'ueery ansxv Assessed%%DorsdmeliCb: r Z
i 'any:Cie,Si tie essence st s v.•-re a•Into a-s"0!eeceeaa-g one('I acre elat.mmedatoy surrounds that stroeture is used to prolate imetre.:esrshe the use and `',cn
or Ire*spoon ut'i ant to omduce.com_s
(2
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State Co.irry ars'owns,S I Is Clamant Vaca\rg a i-r _stead,
IOyes No
t Sr. /J��'//�J --
II hereby certify the above statements are true correct and complete I S LA��'✓'sue / �4,�.Ii� SIGN HERE
A=wag,e'^er:ar,n,.est.:M'O see t '.rr ildf•1 Jr,:Z;•'':off', s nss Al Vacetcd^encs:eia f any(number are u,reez city.state,and Zie wide) . 0
ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Eacoeding One(1)Acre Immediately ((1)
Surrounding Residential Improvement 1
Other Land (2)
Total Land(line I plus line 2) (3)
Residential Improvements or Dwelling (4) I
Annually Assessed Mobile I
Manufactured Homo Garage (5)
I Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) 1
Total Value(Lino 3 plus Line 7) (8) I
-- -- i S.gealurc of Assessor Date Signed(dare.month,year)
I hereby certify the above is true,correct,and complete
.e.•,4 a.;...S gi aa.rc d'Ai,::c• Date Signed(dare.month.year
)
/ i • ,4-. t ct.-1GLAs. y-9-zo 254
STANDARD DEDUCTION ALLOWANCE
22 pay 20 Lesser a'SCC's a"-e assessed cake cf Ire homestead or 548.000
4'ora•I,nRa•c•'y'an,';ire,M^.•srli :tic u m pl f_s:edvu pns'worded in IC 6-I t-12 to a modle home that S
.5 ICI assesses as Tar Deepen-,7 na a m.r arr1C:,red^time!rat rs not assessed as real properly may not
I ercee p ono-half I1,2)of and assessed ralrie of the mobile Rome o manufactured none
5 gn,rt.c 'A etc: "—L—,. _.—- Date Signed(maim.day.year)
I
DISTRIBUTION Of;nal-Cp.env A.d".o•a e Stat:e:Croy-'rixeatier (,/
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