Homestead_Haas�, CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� S4ite Fortn St73 (R6 / 403)
Prescribed by the Department W Local Govemmem Finance
INSTRUCTlONS: See reverse side /or Iiling insfmc(ions.
I (We) \
I�((VJe) occupie as our principal place of r si ence the following
J I(We) owned ❑ Are buying under wntract
�a'�
FORM YEAR
HC10
FI
iQ.Je� certi(y on the 1st ay '%March, ,
real property for which a Homestead o erty T 't " r � :
� GI830N COU TY AUDITOR
Have a benefidal interest in the enlity that is liable for the property taxes on the properry and that owns the property or is buying under a conVact.
If 6uying on conVad, Fee Simple ownefs name
Recordels office where conVad is
Record number � Page
Caunty Twmship Taing datri ( ty, f ,_ to�,thip) � .
lW•
�@ryq�n bero �/O (7/' , O egal d nption Is properry in question:
J v Y u a [�Real property ❑ Mobile Homo (I.C. 6/.1-7)
If any portion af Ihe residenllal sWcture w the nd no� axceeding ane (1) ave Viat immeCialety surrounds Ihat sWGUra is used b praduce income, desaibe Ne use anE portbn
of ihe proDerty ulilized to produce inwme.
SIARlO[\1 �1 W IM1:/!+MI MAS�IRFA PoRV -11A
.�tift0�'EUBI'�inTlbMRDMMYli:Ta.9v ll.F9[NBmBYR1EOEPMMEIfUFL(It:�ICrU'ELYNfTiIP:A'fEMS1.1�J.1
Gibson County Auditor -
101NMain �� � � � 1 "�' � '
PRINCETON IN 47670 InJiciduals and �narriN coupla are Iimi�nl Io orc hame�caJ AandaN �Nu:uon. As Ne reccipt oi �his dMuaion 6ecm�es
merc beneficial, there is morc incenme than erer (or homrsrcaJ (rauJ. Ilomn�eyJ imud ca� higher �ac bills (or all: therefore.
� HEA li�l-f-?OW requirts u�pa�en x�ho receive the hanestead <�ndard deJuccion a.eri(y tha� they are eliciNe to recene the
benefit aN to p�a'idc aNlitional idrntiipinc information neces'vn� ro allw' counn em'rmmrnt m betrr monimr homrnead
filin�.'Ihis infarmatinn aill br AeFV confideNial anJ on only M aarex�eJ 6r amhor'veJ rounly n(Ticiafs. l3e Ik�unn�� o(
L«al Gm<mmcm Fiv�rcc ..ill u�c chis fnformacion io crw:e twis Qut will h:ln �i1' aRx+aL, climiv¢ homumaJ tiaud.
558
Shawn A Haas
3687 W 75 S
PRINCETON IN 47670.8152
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Taspa��er \ame
Haas, Shawn A/Rebecca M
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Prooem� Addre�s
kz
rei�c��on in a7a��
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State Parcel Number Lesal Descrii�tion
2611-16-200-004.086-027 oos-oaos�o0 Snt�DSTONE P�aCE LOT
—_. '� _ . _ _ _.— 3PT/4 — _ — _—
This form MUST be returned to County Auditor's office.
Please do NOT send this torm back with your tax payment to the county treasurer.
�� �
Owner 1 First Middle Last
S�cz w n a( Q�1 /-� cz.a.s
ng Address (number nnd itreel, city, smte, snd ZIP code �'$ume ns prapem add�ev
3�g� 1.,� �5 S t`�r�n���-o�l� Z� �I�cn� �
$ocial
Spouve First Middlc Last
�e�eccc� �m�, �he�1�2 u �a-S
Mailim .4ddress (Number and slrtt4 ci�}', s�alc, and Z[I' code) �me u pmpem addres�
��4�1 �.; �z � S p�,ncE�m ="N 4�� � � o .
Swial Stturity Number (Iaa 5 digitt) Dm�a's Licensd5tate ID Number (1azt 5 digits) O�her (please speciF in Pan 4 below�)
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Each undersiened czrtifies, under penalry of perjury�, that the abovz and foregoing infortnation is we and corrzct and that he or she is elieible to
recei�•e the homestead standard deduciion on this propeny. Each undersigned al>o understands �hat, by claiming additional homestead deductions
unlawfully, he o; she may be liable (or back taYes and substarttial financial penalties.
Ownn I Siymtum Uste Telephone
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