Homestead_Byerly CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State ccr^.54'3,R'e '27 HC10
i.-- y'escnbed oy the CeC'_..,,.. a c.
INSTRUCTIONS See reverse side for filing instruct ons
NOTE Telephone,Social Security,driver's license state identification and federal identification numbers are confidential under IC 6-1 1-12-37.
CERTIFICATION STATEMENT
Vie Q� _cart ty tna'I ice:occuped as my;our;pnnapa'place of
, s-�� gsg�o.is dee c- -ea prove ty- er:antra=for.v cr a Homestead Prcpe y Tar Sla^der7 Ded,.ct.cc s he cy c'a'^'.ed or the
__- _3' ;fled 7 /�f9 r..a:_of oanotare, I .._
:. ❑A•- a'=_ _ , de'recorded ccr:rac-
❑ a-e e tt ec to occupy as a tenant-sra-Ce-c`a==cpe'atL:e rc_s rg corpdrat.e^
❑ ,s e a cenefc.a..nterest In the trust cr tie .] '?Gape^. - :e tee terms 7f a 5..a:h-e7 pe•S,^a'ma de-ze!--sl
[]Am;are;the shareholder,partner,or membe•of:re a•:-:'•a-.2.. :._;_'--e'q
CLAIMANTS INFORMATION
if Buying on Contact Fee Sample Cane's Name
Recorders Off ce'Jb'ere Ccrtract-s Recorded -. ..-ter I'age
_.-
PROPERTY DESCRIPTIONCounty Tov.-
•
t�](J�
l//,�_)
2&'yif,AC IO Ma7q-Vdv e'y ❑. .-../Assessed•.'chie f.or-e.C t7_
a^y po^..on of the res•de-tia structure or the la^,d rot estee^7,:re a=re:• ,r;sr cv:15, at st .ae s se7 a...duce.^,come descr be the use a^d port_r
of the prove..^-y at'-zed to prcdce income FILED
PROPERTY OWNED ELSEWHERE BY CLAIMANT APR 0 9 2024
State County and Township s 2'3"'a-:-a_ ' 3/estead'r 'f hn-.�_I ��/'��� 1�
- --- ❑ es LG 1►/I 64.4.€a./i Y4(.LrE',fijJe)
I hereby certify the above statements are true correct and compiele 0IB80N COUNTY AUDITOR
-r sra•- _: r _. - - : r cera :,, Mare a7a Z.o
30/ 5/v1, Au At-o
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately ,1)
Surrounding Residential Improvement __-
Other Land - --- i2
•
Total Land(line 1 plus line 2) 1(3i
- i
Residential Improvements or Dwelling t4
Annually Assessed Mobile I —
Manufactured Home Garage :5i
Other Improvements (6;
Total Improvements(Line 4 through Line 6) !'r
Total Value(Line 3 plus Line 7) (8!
_._ ----- S-.^,ra'rec'Assessr
I hereby certify the above is true,correct.and complete
decrying scan^-5g^at,a of Audtt
STANDARD DEDUCTION ALLOWANCE
20 -_Pay 20 - Lesser of SC' .-e as:-.:-..,_e: 7e c-estea`r 14: _
N'o uitrstandrng any otner crovrs,cn the s.."- • - - ' _ .. __• __- _ - _ ,r - - - -.
is not assessed as real property or to a• e _ _: - ��er •
e.ceed one-haf,b2,'of!he assessed
i Sigrat.re cf Ayd •
ev -k — 919�a�
DISTRIBUTION , :-a = - .-r__7__.
°age 1 of 2