Homestead_GoochGibson County Auditor
701 N. Main SUeet
Princeton, IN 47670
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APR 5 2011
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(�',��SON COUNTY AUDITOR
Percy Leon Gooch Jr Jr.
4266 W Old SR 65
Princeton IN 47670
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Individuals aad rtmmed cauplcc are Gmited m one homestod stsndard deductioa As �e rtreipt of thic deductian hecomes
morc bencficial, Iherc is more incrntive Ihan e�xr for homestcad Geud. Homestcad fnud cauus hi�cr lax bills for all; therefore,
HEA 1314-?009 rtquircs tacpa�ers win recenx thc homestwd sundazd deducuon [o �xrify chat fhey ere eligible to receive the
bcncfil and to pm�ide additional idrnufqing informalion necessary to allor- county gm�emmect to Settcr moni,nr homestead
filings.'fl�is mfortavan will bc kcpt confidenciai and can onN bc accessM by authorired wunro o�cials. The Uepvm�enc of
I.ocal Gwernment Fvunce will use this infortnation ro create tnols Ihat will helD county officals e:imi�te homestead frxud.
Taxpaver.Name
Gooch, Percy Leon Jr
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4266 W Oltl SR 65
PRINCETONIIl47670
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State Parcel Number Leqal Descriation
26-11-16-100-000.908-027�PTNW 16211 1273AC D-n
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This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the cou
Addms (¢umbcr �d;trcct, ciry, state, and Z�cadc)
5
5 digits)
Drivefs LicensclSUte m Number (lact 5 digit5)
5me
sum
Snmc az property addless
Ot6er (plcasc specify in Pa�
SP(Ci� 111
treasurer.
undersigned certifies, under penalty of perjury, that the�above and foregoing information is true and correct and that Ne or she is eligible to
+e the homestead standazd deduction on this properry. Each undersigned also understands that, by claiming additional �homestead deducrions
rfully, he or s6e may be liable for back ta�ces and substandal fmancial penalties. � ,
Si�ature
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e.� 3� CLAIM FOR HOMESTEAD PROPERTY TAX �FORM I� YEAR
a��'r CREDITISTANDARD DEDUCTION , i! HC�o-t-+� - �
�� Siate Form Sa73 (R2 / 5-92)
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WSTRUCTIONS: See reverse side Ior liling instrucrions.
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CERTIFICATIONSTATEMENT „,�,4no A ��
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I IWe) cenify that on the 7st day of March. 79
.�) occupied as our pr ci ai plac�of residence ihe following es ribed real property for which a Homestead Property Tax Credit is hereby claimed:
�y I(We) owned ❑ Are buying under contract
❑ Have a beneF.cial in;erest in the erniry that is liable for the properiy tazes on the propeny and that owns the property or is buying under a contract.
CONTRACTRECORDED
II buying on conVact Fee Simple owner's name
Rewrder's o.".�ce where con;ran is recorded Recortl number Page
PROPERTY DESCRIPTION
County � Township Ta.ing di�t (ci1y. lown. :ownship)
Parcel number I Legal
ot the resldenifal slmcWre or the land not
y utilized to produce income-
1 o ) � �i - o� - ` � � . �. ? � r-� ,..
1 acre that immed�ately surwuntls thai stmaure is usetl to produce income. tlescribe the use and potlion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
Counry Township Couniy Township
��eby certify the above statements are true, correct and complete. � awre cia� am
Atltlress (numbe� ano s1ree�. ciry stale LP code)
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre fmmediately I' � I I
surrounding residential improvements.
Other land I (p)
Total land (line i plus line7� (g) I I
Dwelling (a) I
Residential improvements
Garage (g)
Other improvement5 � (6) I
Total improvements pine 4 �hrough line � I(� � I I I
Total value (line 3 p6s line 7� (8� I I I
I hereby certity the above is true. correci. and I SignaWre of Asseswr IDare signetl
complete.
�fyirg ac�ion - Signa:ure ot Audi;or Date signed
ALLOWANCE
79 Pay 79 _ �
Lesser of v2 Homestead I
Valuation or 52.000 S
signcd
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