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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / 5-92�
FORM
HC70
YEAR
INSTRUGTIONS: See reverse sitle for 61mg mstructlons. , - �
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CERTIFICATION STATEMENT
II(We) ._ certify that ��� 1�d�y �rch, 19_
�I occupied our principal place of residence e following descri e real property for which a Homestead Pro erty Tax Credit is ereby claimed:
We) owned ❑ Are buying under contrac�
❑ Have a beneficial interest in the eniiry that is liable for the property taxes on the property and that owns the GI SON l,: I i M�Uv� � °�
CONTRACT HECORDED �
Ii buying on contract, Fee Simple ownets name
Recorders office where contract is recorded Recortl number Page
PROPERTY DESC TI
County Township Taxi d lrict dfy, to , rown5 p
r n ber I� � Ofr'j'�egaldescnption -
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any portion of ihe residen6al structure or the lantl not exceeding we (1) acre Ihai immetliatey sunountls that suucture is used to produce income, describe the use aM poNOn of
Ne properry uulized Io produCe income.
' PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Gounry Township Counry Township
Signature ot claimant
.ereby certify the above statements are true, cortect and compiete.
Address (numbeiantl streel, ciry, state, ZIP cotle) ��� `�
R.3 � N 7
� TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
ASSESSOR USE ONLY VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (��
surtounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvemenis (line 4 through line 6J (7)
Total value (line 3 plus line 7) � (8)
I hereby certify the above is true, correct, and Signamre of Assesor Date siqnetl
complete.
Veritying action - Signature of Autlitor Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
lesser of 1/2 Homestead S
Valuation or 52,000
SignaWre of Audimr Date signed
I __
Gibson Cocnty Audiror
101 N Main
PRINCETON IN 47670
0
1334
SNI£ {OFN'! W tlL'/ Yrvl
iRl.�SIIIfAWRV:}IA
InJiriJual> avd marricJ mupks are Iimi�N �o nre homeaead �anduJ JNuc�ion. As �he rarip� ol'thii deduction bccomcc
marc beneficial, thrrc is morc incrntne than e�er fur humestead frauJ. Ilome��r:wl fraud cau�ss highrr ta� bills tar all: �hrrtfore.
HE.\ 13�N-3IXI9 requirts uxpa��crs aho rmivr thc hanestead s�anda�J Jnlunion m.eritv �hat thcy are tliciMe to recei�c �h.
benefi� ami ro pra'idr aJAi�ioiul idrntitying infumiatiun �c�.'vn� �o allw� county earmment to betrer mmimr Iromrneal
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fili��... This inPamuiion wiil br Aryv confidnuinl and ean nnh' M aem�eJ hc autMriuvl counh' nfficial. Thr Depannunt nf
I.ocal Gm<mmrn� Fiwnee will u e chis iniomwtion W arcau 4tds dut a'ill h:ln rounn' ufirials elimirttic homcs�cad iraud.
Taxpaver Name
Gray, John E
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R3 f3ox
Princr�on 1;
John E Gray ��
553 N 225 W State Parcel Number Leeal Descrii�tion
Princeton IN 47670.8559 �
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Andress (nurtibci end�sucM, ciry.—smce.—nnd ZIP codc) .
5S� N ��JV�I PRITICF
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a; propery. � nCdrsa� — - --
Pan 4
� s�,»� �, P�oany �aare�
(las� S digits) � Othcr (plc+sc spccify in Part 4
undersitmed certifies, under penalty of �pury•, that ihe above and foregoing infurtnation is trve and correct and that he or she is elieible to
�e the homestead standard deduction on this propeny. Each undersiened al>o understands that, by claiming addiiional homeitead deductions
�fully, he or she may be liable for back taxes and substantixl financial penalties.
1 Si�metaac Uetcl � 7'elephonc �
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