Homestead_Hollingsworth CLAIM FOR HOMESTEAD PROPERTY TAX I YEAR I
Il FORM
j!¢�aAj STANDARD/SUPPLEMENTAL DEDUCTION HC10 2022
Ptes ribed b the
Prescribed by th 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 am confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) Stephen R. Hollingsworth 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, //— y-ZO 2—Z- (date of signature). I(We):
II 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 occupy the property under the terms of a qualified personal residence trust.
❑ Am(are) the shareholder, partner, or member of the entity that owns the property.
Q
Y
CONTRACT RECORDED to +I—
I(buying on contract,Fee Simple owner's name rt
- O
Recorder's office when contract is recorded Record number Page 1-i
U1
coPROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Gibson Center Gibson, Center
Parcel number Legal description Is the property in question'
26-12-02-300-000.798-004 PT SW 2 2 10 14.09 AC
m Real property ❑ Annually assessed mobile home(/C 6-1.1-7)
If any portion of the 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 utilized to produce income.
N ')
O -
PROPERTY OWNED ELSEWHERE BY CLAIMANT Ltd
State.County.and Township Is claimant vacating a homestead?
❑ Yes Z No
Signature of claimant„..---7 � C
I hereby certify the above statements are true,correct,and complete. / / � f ^ C
`1 4 T ,
Address of contact(number and street,city,state.and ZIP code) Address of vacs homestead,if any(number and street,city,state,and ZIP wde)Fiit�
3982 E 50 N, Princeton, IN 47670 NON-RESIDENTIAL
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE VALUE
Land not exceeding one(1)acre immediately (1)
surrounding residential improvements _T__-- ---
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/ I Garage (5)
manufactured home
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6) Date signed(month,day year)
Signature of Assessor
I hereby certify the above is true,correct,
and complete. Date signed(month,day,year)
Veriyl action-Signature of Auditor /
—I • "f LI�I �L�
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Notwithstanding any other provision,the sum of the deductions provided in/C 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.SigriDale signed(mourn,d-a7y,year)
si9 al AuditorJ� ' / f t. _ 1 i- 1 S. C_e)2-DISTRIBUTION:/(Original-County Auditor,File-stamped Copy--LT/axpayer
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