Homestead_Friedman (3)d�. R•n
"°s CLAIM FOR HOMESTEAD PROPERTY TAX
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CREDIT/STANDARD DEDUCTION
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INSTRUCTIONS: See reveise side lor /iling instructions.
STATEMENT
- FORM –
HC10
EAR
I(We) YW Y�LVIJJ�IYVYWV\� J/lA4Sd(//V�,R/y`: cenityihatonihe7stdayofMarch.l9�
_) q pied as our pri ipal ace of residence the foliowing described real property for which a Homestead Pmperty Tax Credit is hereby claimed:
� ,.
� I(We) owned ❑ Are buying under coniract ,�
❑ Have a beneficial inierest in ihe entiry ihat is liable for the property taxes on the property and thai owns ihe property or�y�g�nder�n�c
. CONTRACTRECORDED . Z
If buying on contraci, Fee Simple ownef5 name� �
Recorder's oNice where conVact is recorded Feco nur6 ' .�
. AUDIT
` � �� PROPERTY DESCRI
County Township , - • Taxing
^ rc n mber,., ^^ /y� Legal description
/
..1.% JJ C� '
If any portion of ihe residential swcmre or lhe lantl not exceeding one ( � acre that immetliatey s
of the pwperty utitized to produce income.
Coumy
PROPERTY OWNED BY CLAIMANT IN
certify the above statements are irue, correct and complete.
numberandstreet. ary, slate. ZlPcode) /J . c
ASSESSOR USE ONLY
Land not exceeding 7(one) acre immediately
surrounding residential improvemenis.
Oiher land
Total land (line 7 plus line 2�
Dwelling
Residential improvements
Garage
Oiher impravements
Total improvements (line 4 through line �
Total value (line 3 p�s line �
I hereby certity Ihe above is true, correct, and
complete.
�fyirg action - Signature of Autlitor
19_Pay19_
Lesser of 1/2 Homestead
valuation or 52.000
THUE TAX
VALUE
(�)
(2)
(3)
(4)
(5)
(6)
l�)
(B)
Signamre of Assessor
�
� . �S � /a a, S 3 �
Nat strucWre is used ro produce ir�come, descnbe Ne use and portion
2� — ' ` `
ASSESSED HOMESTEAD
VALUE VALUE
ALIOWANCE
��� � 6
NON-RESIDENTIAI
VALUE
Date sgned
Date signed
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
3513
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.\�YIttT'f11 PT �T1iE MNRUIIF M'�v�i.'�a. ry�v
PRfYlT10mOY illt DF] Vt1MEViOF
ixrwn:tu racv a�n
InJiviJua� auJ nurriN coupla arc limi�ed io orc homeucad uandanl dttluciion. As ihz rctttipt ol ihis dafuctMn bcconree
nwre brneficial, tha< is morc incenti« Jun r�er (er honmxael (rauJ. Ilome�ttaei fmuA causes hi�her tai bills lor all: them(ore.
HHA I;Si-10W rtqui�es uxpa�en xho rcmice �he hanestced sundard JeJuc�ion to .eri(y tfut the} am eliciMc �o rccci.e ihc
benefi� ani ro prtn'iJe a�Witional iJrntiiyinc infwmation Mcosary w allw' counn� ea'emment to bener muniiur twnrsttaU
�ili��_ This in(ormmion will 6e lqv conlidmiai and can anly M arerxed F�' aWhnriznl counh' nffitia@.'Ihe Ikry+annrcni n(
Iycal Gmcmrnrnt Fi�uze will um this intormanun m.rcam nols �hm x'ill hcln mmn� ofkia6 climi �wic humesicaJ fiaud.
Anthony James / Shannon Friedman
768�5 Dogwood Lane
Princeton IN 47670.8866
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Taspaver Name
Friedman, Anthony James / Shannon
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State Parcel Number
—__ 26_12-15-200�003.392-027
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�"��s
g Addrtss (numbcr nnd �teeet, ciry, smic, and ZIP codc)
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$rcuril}' Numba (last i dieits) Dm�a's Littnsc/State ID Numbcr (lasl 5 digiB)
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) �Q.v�,�lv� .. l�e �
ilim� 4ddrcss (Number and svee�, cit � siaie and "GIP cuJr)
�ic� 8 �o � Lc�
�ial
IL 13ox ?t5 An
Princcton 1,� �767
006-03392-00 PT_ E NE 75 2 70 2S3 AC
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u� �umc us p�opcm eddrcs, - _ _
�Yi V� C¢..-�-y� � �� ` � �P�, �
O�her (plcssc specify in Pan 4 below) �
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Fr,��
� Sume �u p�openy add`a.,
PIl� �
7co� o
undersi4med cenifies, under penalty of pequry�, [hat the above and furegoing informatiun is we and wrrect and that he or slie is elieible to
z the homestead standard deduction on �his pmpeny. Each undersicned also understands tha�, by claiming additional homestead deductions
�fully, he or she may be liable for back taxes and substantial financial penalties. I
I Si�ma4ac Ihte 7'cle0hone �
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