Homestead_White (3) Reset Form
CLAIM FOR HOMESTEAD PROPERTY TAX
' � FORM YEAR
:•` 1k1' STANDARD ISUPPLEMENTAL DEDUCTION HC10 2025
.� slate Form 5a73(�f 12-z�)
-y•-• Prescabed ty tie O.pRlmenl of Local Government Finance
INSTRUCTIONS:Sea reverse side for filing instructions.
NOTE: Telephone, Social Secunly, driver's license,slate/dendhcalion and federal identification numbers era confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) Christopher&Layne While certify that 1(we)occupied as my(our)principal place of
residence or am(are)buying the I cubed real property under contract for w^lch a Homestead Property Tax Standard Deduction is hereby claimed on the
date this upplkabon;s'geed. le/-I f-Z5 loam of signature; I('Audi
? 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 occL+yy Ins property under the tens of a qualified personal residence tr,Ist.
Q Am(ere)the shareholder,partner,or member of Ilse entty that awns the property
r Buying on Contract Fee Snipe OwItera Name
Reconfsr s Off,c.Where Co'u.a t N Recorded I Record Marbe+ Page
PROPERTY DESCRIPTION
Carty Townsrr0 Taxing Mato(racy,town.tome") /i
Gibson Johnson ,;Y_
Parcel Number legal Deunpeon Is the ptvpsrty in question.
26-22-12-300-002.251-024 THE MEADOWS LOT 18 a veal P„),,,rr, O Amu..,!Asaased tdobole i ,e uc 6;11.11
If airy parson of the resreen sal tWdure or the Lard not sxcesdng cue t t 1 acre that immediately surrounds teat structure is k.sed b produce,nr ome,descnts etc use and portion
of the property treaters to produce income.
2 -- 2 -
0 0 -0 o 2 . 2 >--- ) _ o 2 L;
PROPERTY OWNED ELSEle:Ho-F BY CLAIMANT
Stale,County,and Township its M C eaaesteed7 Yes ❑ Ne •
S+gnat.rre 61 Cla r,`s*r
I hereby certify the above statements are True,correct,end complete. r Y `/ s' ' �-- / +
I� • J 1
Address of Contact(ntrnare and strife city,sista,and LP code) /WM*el YmeAed Metslest'en4 A any lumber end street arty.Xir..! .aro DP code/
11804 S Honeysuckle Lane, Haubstadt, IN 47639 'ZS? Csenev4. WN Ooonw;I le,TAf 4760 t
ASSESSOR USE ONLY ASSESSED VALUE 1 1IOMESTEAD VALUE I I )h•:'ESIDENTIAL VALUE
Land Not ExceecOng One 1.1)Acre Immediately (1) MID
Surrounding Residential Improvement
_ _ _L
Other Land (2)
Total Land(line I plus lino 2) (3)
Residential Improvements or Dwelling (4) ' (f cr .,
Annually Assessed Mobile)
Manufactured Horn. Garage (5)
Other Improvements (6) rlr�� .
Total Improvements(One 4 through Line 6) (7) 8 ' Si
s..--stD
Total Velum(Line 3 plus Line 7) (a) `gUl1/ C04 yJ,.i
Signature of Assessor Date sgrAfiiii reilifTgaii
I hereby certify the above Is true, correct,and complete. ^fff/7-01
Verifying Action-Signature of Auditor Dale Signed(date,moan y.aq
STANDARD DEDUCTION ALLOWANCE
70 Pay 20 Lesser of 60%of the assessed value of the homestead or S48.000.
,4dwithsfdnding any ether provraron, (he sure of the deductrons prvviir+d in IC 6-1.1-12 to a wrote*home ghat $
s not assessed as reel property or to a manufactured hurnre that is nut assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or man ufactured home.5i,pnaturesof Auditor - Oats Signed(n,o Il day.year)
v� ,r � G IC — tom - apt
DISTRIBUTION: O"glnei -County Auditor.FlisStamped Copy-Taxpayer
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