HomeMy WebLinkAboutHomestead_Bailey (4)'�"
f
CLAIM FOR HOMESTEAD PROPERTYTAX
STANDARD ) SUPPLEMENTAL DEDUCTION
FORM
YEAR
\ j
Sate Farm $473 (112117.25)
Pmscrtbod bytho Depanmenlet Lo<:al Gwr meal Finance
H C10
114STRUCTIONS: See reverse side for fiTing instructions.
NOTE; Telephone, Social Socuf ,, driver's license, stale idonfiricalion and federal tdtonfifcalki; numbers
are eanftdarifiel under iC d• f.1-12.37.
cadlty that I (we) ouupled as my (our) ptindpal placa of
residence or am (are) buying the f " in des d r fry undo ct for which a Homestead Property Tax ndard deduction Is hereby claimed on the
'
date this appricaKon 4n signed, ate of slgnature).1(YJe)GL�3 r
tTvh. ❑Am (are) uying under recorded contrad
❑Am (are) entitled to occupy as a tanant-Aockhokier of a cooperative housing corporatton-
❑ Have a bnnat(ctal Interosl to the Uttar or the right to occupy the property under the terms or a qutifed personal residence trust,
❑Am (are) the shareholder, partner, Or memher of the entity that owns the property.
INFORMATIONCLAIMANrS
N eofGaylfa'aatpepNneme
'r
Te/-�piwnaNumberofGarman! EmaOAddass
(t!/ �
�• t I ry
r! Pi .!Z 'r< i
'J • �" r �
s t
� iva
LC .% err �1 4•�
1 •iL G�( 1�+,. r r)/`L
SoJnlSecurity Number orClaimant ens! two d:¢uJ U
2-7e f
0"rg nxa J 1 emniCevan I Omer Number o etmant(esr Na0,01s
(Ar'pff aftfeonryifappftanfdoesnorhaveaaaclelsecv ynumtmr)
is3UrygM.",
f,Vj/
Name of Gtalmant's Spouse fiaflltinam0
S+-Sal Seanity rr:nbar efUolm5nrs 3pnue pest fi:w dyers) s rnso eat. utnrs ter un +w; a.nsan,[a.p•:usoltp n9.1 L^su�nfl5la!a
(App:kaWe onyi! spp!:csnra spoure does ncJ haxa a secirl sec r
! �
■ ••r s
If B+rring on Coomaet Fen Stmpla Ownaes Name '
Recorder'sOlfeeVi"ConlraclisRecorded i (
fb. ;Ju�jF�otr Faga
n
County Tawr��tat3yy' - f Taking tricl (dirt I +vP)
ParcelNumser Le2dDesuiplIon
Is
the opartyroqu.,. •N'Y eX
--��-a ��
a
ed pro twty ❑ Annunity hkq }line 00 &1.1.7)
1t any portion of the resketdFet sWttura orthe tend rwl ert•edtng one (1) acre that immediately surrounds that slmclure Is used to produce In -me, dau d the use and poftn
of the ptopady ufted to produce Income.
PROPERTYOWNED ELSEWHERE BY CLAIMANT
$tato County
Township
I; Cfarman I VawVng a Hgmest•ad7
❑Y s ❑No
.Atu[O Ot G•iman'
I hereby Certify thB above statomrrtste are [rue, corcoU, ankm e1e
Address of Contact{numberandstreet, cdy, state. and ZIP wade)
tease 'cur Homestead, if any (nameerand SIMCI, dtl, stale, atldZIP code)
ASSIE�ORUSEO
Land tlotExceeding Ono(1)Acroimmedlataly
- a. s
{1)
■ •s
• n
Surroundin Residenlin fra movement
Other Land
(2)
Total Land (Line 1 plus Lino 2)
(3)
Residential Improvements or
Dwelling
{4)
Annually Assessed Mobile I
Garage
(5)
Manufactured Homo
Other Improvements
(a)
Total Improvements (Lino 4 through Llno 6)
(7)
Total Value (Lino 3 plus Line 7)
(S)
I hereby certify the above Is true, correct, and complete.
Stgaalnre of Assessor
Data Signed (dale, month, yeeq
Vodytng Avian — Slpraturn of Auditor
STANDARD ■
Data Signed fdato, mantl, year)
For assessment dales aRor Decamber 31. 2024. in 2025.
20 Pay 20 $40,0W: In 2026. $40,00D: In 2027, S30.000• In 2028, $20,OW:
In 2W9, $10,000; and begtnntng with the 2030 assessment &Irt
and foreach assessment data thereafter, $0.
Notwithstanding anyorhorprovfs:on. the sum o/the dedurfforts provded in IC C-1.1-12 to e
$
mobile home that is not assessed as reatitrraperlyor 10 a manufoctueed home that Is not
assertedes realpmperfymaynot exceed onal"(112) ofthe ossassodvalua ofthe mob;le
homeor nufaOuredhom6.
Sign 6i Eimr� /"�. � I -'
Dats CfOr>gff car
yC
DISTRIBUTION! Ceo;nal—County Aud-tw,Fao-5•amped Copy—Ta*payer
Page 1 of 3