Homestead_Goldbach (3)CLAIf� FOR HOh�STFAD PROPERIY TAX CRmIT.FOR YEAR 19 � y
SEE BACK FOR FILING.INSTRUCTIONS
Z,`�,Ne) �ioLeBAGH�m�cNR&b: �,EQ/.��Of/ELYA/E n/ certi£y that on the lst day of
, F�---�n, 19 '/, I, (F1e) occimied as our princioal olace of residence the followinq described real
.�erty for which a Hmnestead Pmperty Tax Cr�lit is hereby �; *�; claimed:
� -'
I, (i�) �'v.,mai .
� are buyinc? unler contract
� have a beneficial i.nterest in the taxoayer
D-oo�sty Description in V� So,�l Cotmt}'
Taxing District (City, Twm, hip •
oo� -po�"y
/
,� . .
p�rc�l tiuwer or legal desc-siption strnm on tax statare�t:
�ENGN /rlAR�C �ESr �
I� buvina on �ntract: R�mers nartie (fee sinrole own�s)
Contract recorded in Remrder's Office - Record No. Page
If any oortion of the residential structure or the land, not e�eeding one (1).acre that
irm�ediately siuxoimds that stnicture is used tn pxoduce incane. describe the use and portic�n of
the orooerty utilized to produce income
Pny other cntmties in which individual owrs or is buying real pmperty:
seby cestify the above statem�t is true, mrrect and cortq�lete.
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City, State airl Zip G
*Tntiividual either a��ns or is buying imer a oontract that provides he is to pay the
orooerty taxes on the residence, or has a beneficial interest in the taxpayer•
- FOR ASSESS(A2`S USE ONLY -
'iive Cash
Value
iand not exceeding 1(one) acre ircm�ec7iately
stsro�linq residential i�rove�ents (1) �.ZJ�o
orr� i,�a ca) ° �
�btal Iand
Pesiaential InQmvere-nts
Q`�1°T SIIC�2bVHilPA�S
� �. Imorovarents - Line (6) plus
I hereby certify the above is true,
!Ai
C�
.. . o.
(3) /.ZSo
nwei�w (a) z 5�70
Garaoe (5) �
Total (6) R`t%�
�7� J
(7) �s (8) (e) �� SF7o
correct, anl mtmlete.
- ACTION BY P.UDITf1R -
Date:
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
793
A+lichael V / Jacquelyne Go
2475 N Benchmark Dr
Princeton IN 47670-8524—
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TRfA51iAlAfU0.NilA
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Indi.iduaL anJ rturticd coupb uc Iimi�tJ w nre home�tead �tamlaN cLYlu.�ion. As the �tteip� 01 Ni� Jedunian becomes
more benendal, ihere is more incentnx Ilun r� er for homestracl fr�ud. Nomc�'teyi fauJ causes highrr tac bills (or all: thrrefar.
HEA 1;i.2009 requim u�pa.crs w�ho rccei.c �he hanestcad stsndard Jedunion in verity rfut they am elitiNe io mcene �M1c
benefi� an1 ro p�w'idc mWitio�ul idemii�'inv inWrmauon nem.v'�n� ro alloe' counp� @mcmmenl ro bever mtniror Iwmesesl
�iling,.. This inlurmaiinn v'ill M AryM ttnfdemial mA �an only Fe acec:sed 6r autMr¢eJ mum�� nf7¢ialsj"ITr Ikpanmenl of
1-ocal Gwcrnnem Fi�u�rce xill uw this info�mation [u crcam twis that �vfll h:ln iounn ulficiaLa climinL�e M1omesmad fiaud.
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Ta�nacer Name
Goldbach, Michael V / Jacquelyne
R3 �3os �
1'rinccton 1\
State Parcel IYumber Leyal I
26-05-31-101-000.654-027 OOfr00654-00
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:r 1 First Mitltlle
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�c AaArcv �numGer m�d s¢at, riry. smcc. and Z17 codc) � Samc :.; pry:f.c u:,:��;
�75 N(�jtmcCvrna,k i�2 Piz �nce ;aN sN �{7�� o
I Smurity
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e Address (Numbet anJ eYrecl, city, swic, anJ'LIP coJe)
E7 5 � l3emchma�h .�2 ��� r�
Saurity Number {lase 5 digirs) Drivds Liccn5N5taie ID Nianber �lazt 5 digits) O�hcr
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� Same u pmpeny azldrcu
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s{xcify in Part 4 bclow')
EST 6
undersigned certifies, under penalty of �rjury, thaz the abo��e and foregoing information is true and correct and that he or she�is elieible ro
e the homestead slandard deduction on ihis propeny. Each undersiened al>o understands thaS by claiming addiiional homestiad deductions
fully, he or she may �able for back axes and substantial financial penalties.
I Signa4uc / Dstc 'I'