Homestead_Forkel (2) 'v4 4,
5�,���� CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
1, SUPPLEMENTAL DEDUCTION
slain rn+n L173(R 19/I-23) BCD)
I'm-sr-Owe by the Oup etnlunt..t Int el(:r n.ri rn.n1 I arts
INSTRUCTIONS:Soo reverse side la Ming instructions
NOTE.'Telephone.Social Security,dcttmr's Ircnnsn,shirr rdcnfrfrcatinn and federal identification nurnbnrs am Con(n$nnfinl under IC a.I.I.72-77.
CERTIFICATION STATEMENT
I(hye„reelirrfEMnapre/COn rot phtrenllacliet`-^'-i certify'hot I(me)tr,nrp1e4 ns nr/(our)ixindeal flare or
residence or ran(me)!eying the knowing dnauihed Innt properly under rontrnrl Inr 01110 a I Inrneltenrl I'rn)refty Ins:ilarrinrd Dadurenn h bnrehy claimed cn the
dote Thin npp nrnllom N errined, 11.19.7074 (elate d akjnnfure),I(We)'
0Or n. ❑Are(ran)burying under rnconled mound,
❑Am(am)onbttod to occupy SR n bonnet.slakh rddnv of n cnriunrnhvn Inuring ocrporIllkon,
❑Hoye o beret cli Interest In the Imes(or the dpld to occupy Ihn feolrrrty under Inn term of n nuntilinrl personal relldeocn?tint
❑Am(eon)Inv RhprchdrJcr,partner,or membrr Pr Ilg entry that owns Inn proporly.
CONTRACT RECORDED
If Buyug on Corerod,Fee Simple Owners Name
Recorder's Otrrm Whom Contract is Rpm wpd P,acf?rd r remcre P�nu
PROPERTY DESCRIPTION
County Tcenshlp Tnekr9 District(city,torn,taenrt:pl
G'son Johnson 024
Pere,!Number Levi Dnintplon l Is the properly in rx•u,ca
111❑� Neal Prrgnd'r ❑Nr. Olh irlw,ty!..Te1CFL 1•7)
tl ony potion d the residential structuro or the land rust erceeting ono(1)nun loaf Immntllelely sunwndI Nat srmrtur.is oriel In volts.nr_rrre,9ewtn t n cm+^�prxixn
011ie Ixopedy ullued to produce Income,
26-18-33-100-001.659-024
PROPERTY OWNED ELSEWHERE BY CLAIMANT
Stele,County,and Townswp Is Clannent vaaseg a wx-.esreats
❑Yen ❑no
6 fxv or,Cla'inntr
I hereby cattily the above,statements are,True,correct,and complete, q4 42. Fes. A Ckneyr c l4cp,LL>y( �F
Address of Coned(number and cheat.oy,stale,end 21P code) Adr,ress d vacated Homestead.J arty a:Tet rxr,su:.e,w ZOO G_.lvl
9704 S 450 W,Cynthiana,IN 47612 7212 Little Schaefer Rd,Eville,IN 47720
ASSESSOR USE ONLY . ASSESSED VALUE I HOMESTEAD VALUE !NON-RESIDENTIAL VALUE
Land Not Exceeding Ore(1)Acre Irmnedlatdy (1)
Surround!tiRostmoreffontarrt
Other Land (2)
Total Land(fire I plus line 2) (3)
Residential Improvements or Dwelling (4) F
Annually Assessed Mobile! -61
Monufactured Homo Garage 5 O .r l
Other Improvements (6) -NOV`n
Total Improvomonts(Uno 4 through Uno 6) (7) � t jU0?y Total Value(Lino 2 plus Una 7) (9) �y±± '
Sgnntura of l�isnssdlies'+Q O�C/J Day m,Sgreo(u+. oln,J•ar)
I hereby certify the above It:true,correct,and complete. N
Venty'vq Acton-Signature of Auditor UN Up' Dore Sign a fans.mown)e.to
opSTANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48.000.
Notwidrstanding any other provision,the sum of the deductions provided In IC 6-I.1-17 to a mobilo home that 5
Is trot assessed as real properly a to a manu(oclured Promo that is not assessed as real properly may not
exceed ate-half(In)nl(elf assessed value ri the • home or mnnutnrlw run,nd A
Signature n}Anatol l Y l�)� `kl r)-L Oa1n Slgrr.. (mordh, mar)
DISTRIBUTION:Oi a,e1-County Auddor,Fdc-Stamped Copy-Tarpnyer
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