HomeMy WebLinkAboutHomestead_Hollingsworth� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
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Prasabed by the Deperhnent d Local Gw�a�rreq Fowim
INSTRUCTIONS: See reverse side !or filing ins6utions.
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I(We) � oer6y that on�'I^st d�gl�, 20_
I(We) owipied as aa ' pal place of residence the " descr�ed real popeAy for which a HanesOr.ad Property T�c Cre�i is haeby d�med:
��(We) owned are w�yuig unaer canaact
Have a benefidal mterest'u� C�e entily tliat is liade for Uie property tazes m the propaly ard Ciat owns the property w is buyug urMer a cantracl
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m wyug on mmac+. Fee sirrpe an,ers �vme
fbmrdels of� Mera m�ha�1 ia r�ded Recad numbar Pape
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n ern a readeMial stn,w�e o. me I�d na nmeedine one (,) aoa mal nme6e�. an,w
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I hereby oertiy tAe above 5ta6enwnts are true, cortact and corrqlem.
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�em a�werb ❑ n�m+b rwme c�.c. s,.,-n �
■a ia uaed b prod�ce i�mme. d�be tha ine md pa6on
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. . ' � ' + 4'�, Y`t : TRUE-TAX � ASSESSEDY/i1.UE { F�S7EAD � � f �'zNON�tESlDQ4ilALp�'�e�
., t,aa' f . ,AS�S�R_USE ONIY �� � . ��` *�d ��� �:' , VALUE' � ? 'AT 100%� TN F , � °�.YALUE..'r, fi'. : 5�'ti`� %:3�':'�:,�a-� c.`..'.s�#.- "�a.�'K,a.�,}.'
Land not eueadirg 1 (one) aae irm�adia0ely ' - � ' t�.��` �s��,9 �a+a � };� '��s �}'�`�
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ReSidentia! vrplover.tenl5 or Mrwally ' ,t;-:. � �._?c... �.�.,Y'� .:..r,. �.��^'�
Asse55ed AlabBe / M2rpjfechtled F1ort�e ��Q (5) l in�i� {��e,,,M i`fir.d.?'��-a
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Tdal value (1'are 3 p4s Gne n �g)
I hereby certiy ihe above B true. omect. and sisr�ma of Asaessar Date sigied
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Vaifyiig adim' Sgia4ae of N#LOr Date aigned
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20 _ Pay 2(1 _
Lesser of 12 Honestead
Veluatim w f35.000 E
Si�a6ue of a6tar Date sipned
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Gibson Caunty Auditor
101 N Main
PRINCETON IN 47670
145
IIAR iM]I!)`M 12' I ��vl
InJiviJuaL and rturriN roupkti are limi�ed io orc Iwme�eaJ �tnndard dMunion. As 1he recerpt ol thi� deduction brconres
merc beneficial, therc i� morc incmtne than ecer (or homnie:ul (raud Ilomd�ead Gaud causes hi�her taa 6ills tor all: therefore.
HEA 1333-]IX!9 rtquim.+ taiparen ��ho reccive �he hanes�tad <�ndud �viuction w verify tfui �hq� are eligiNe to rteci.c �he
benefii �N ro p�w�iJe adUitional idrmiirin_ inWmu�tiun rccessarr io allw� counn� emrmment ro bn2r monimr homeseaJ
filin�.'ITis in(ortnalion w'ill br {.ryv confideNial and on only h ameseA M1c w�hor'uN counp� oiTtials. TA< IXpanmrm o(
Lueal Guvemmrn� Fivnce �cill ux this information m creatt ttwls �hat will help eounn� ufficials dimina!e homcst<aA imud.
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Taspacer Name Properh� Address
Hollingsworth, Cheryl A � � G,G� / / ���4
R?F3ox?�J-a ZZ70 �-i%�pl�
� Prtncemn I\ �t7670
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Cheryl A Hollingsworth
�2270 E Top Hat Rd
PRINCETON IN 47670-8843
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g Address (number nnd srccet, ciry�, s[ate, and ZIP code)
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Securiq' Number (last i dicin) Ihiva's Licenx/SUtc ID Nmnber (lazt 5 digiB)
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Addr� (Number and suce4 ��y, sia�e, and ZIP co�k)
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undersiened certifies, under penalry o( pequry, that the aboce and foregoing infortnation is we and correct and that he or she is elfefble to
;e the homestead standard deduction on this property. Hach undersi¢ned al;o understands tha� by claimin¢ additional homestead deductions
rftitty, he or she may be liable for back taces and substantial financial penal[ies. �
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Sig�tature
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