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Homestead_King CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR I Il FORM STANDARD/SUPPLEMENTAL DEDUCTION HC10 I 2022 Q010..) Prat+rib (D1p/1-20) PresPrescribedd byy the Department of Local Government Finance INSTRUCTIONS:See reverse side for filing instructions. NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37. CERTIFICATION STATEMENT I(We) Jerry Kling certify that I(we)occupied as my(our)principal place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the date this application is signed, L-)(--Z(5 Z2.-- (date of signature). I(We): 21 Own. ❑ Am(are)buying under recorded contract. 0 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 occupy the property under the terms of a qualified personal residence trust. 0 Am(are)the shareholder, partner,or member of the entity that owns the property. CLAIMANT'S INFORMATION If buying on contract,Fee Simple owners name Record number Page Recorder's office where contract is recorded PROPERTY DESCRIPTION County Township Taxing district(city.town,township) Gibson White River White River PaLegal description is the property in question: 26-number t Q Real property 0 Annually assessed mobile home(IC 6-7.7- 7) 26y04-o s her 703.045-018 If any portion o he residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion of the property Hived to produce Income. `K�ve� PROPERTY OWNED ELSEWHERE BY CLAIMANT Is claimant vacating a homestead? State.County,and Township ❑ Yes © No .. Signature of claimant I hereby certify the above statements are true,correct,and complete. • ` j.) a. 1V`D - Address of contact(number and street.city,state,and ZIP code) Ail' i o1 vacated homes if any(number and street.city, t,and ZIP code) 6724 N 150 W,Patoka,IN 47666 VVV NON-RESIDENTIAL ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE VAIyIE Land not exceeding one(1)acre immediately (1) surrounding residential improvements ,=; T�) „ ,, Other land (2) �� Ian. 1 i�►`e 2) B��riom t�, a F ' Itrk- • rti o Ilei r Dwelling (4) �;Ti !. T',. 4- manufactured home Garage (5) (p�++�� tl r F f h4.lrOrqqLVC�t (6) Totalta improvements(line 4 through line 6) (7) T iG Iry lre,gil YRa!,rtin 7) Si)gnature of Assessor Date signed(month,day,year) GIBSO Orkili-eytt��►pia' a true,correct, an Verifying �mplete. pate signed(month,day,year) Veriying action-Signature of Auditor STANDARD DEDUCTION ALLOWANCE 20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. /�• r..t 1 • Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ `''� yr tnottexceed one-half(1/2)of the a sessed valuenof theumobile home or manufactured home.(property may rr -• �� Datet eQ( h,day,yP,pr) el+,. (� Signature of Auditor r l//o a G/�-- (Ne'T,,\- 2 3.erif4lf C��(,���:744rit�(jr^„-- ty� p `�rp _ 1 Qt�A ^ ,,�v�tau gam" DISTRIBUTION:O ginel-County \� Stamped Co�-t.,-�W�y page 1 of 2 ` - \4 1 l,V! n 1S ` 4 1