Homestead_Haville�^� CLAIM FOR HOMESTEAD PROPERTY TAX
! CREDIT/STANDARD DEDUCTION
�'E�:
�,� State Form 5a73 (R2 / 5-92)
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INSTRUCTIONS: See reve�se side lor lilinq instructions.
FORM YEAR
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i �We� `�' C/ U/.r� � l�/t!x certify t�op���p,��ts7t��ay ot% c$:;79
��JCCUpied as our ri cipal place of residence the following described real property for which a Homestead Propeny iµu�il�� +��by daimed:
❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in ihe entity that is liable for ihe proper�y tazes on the property and that owrs ihe propeny or is buying under a contrac�.
CONTRACTRECORDED
II buying on conttact. Fee Simple owner's name
Remrder's oflice where contract is rewrtled Record number Page
Counry
TownShip
town.
�Parcel number `S Legal tlescn n /�_ m /�n' pa
�O/�e-� d �W � ���/� /'V�/( �_-/
II any portion ot Ne residential StmcNre or the land noi e,ceatling one (� 1 acre t�at immed�a;ety surmunds tha; s:mcmre is used m protluce income, tlescribe the use antl potlion
ot the pmpeny utilized to protluce fncome.
County
BY
TownShip
�y certity the above statements are true. correcl and complete.
street. ciry, stare. ZIP code)
,UaP�.r� �vt %�
IN OTHER COUNTIES
8 L
To'.vnship
�N Y
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately I(� I I
surrounding residential improvemenis.
Other land (p)
Total land (line 7 plus line 2� (3) I
Dwelling (c) I
Residential improvements
Garage (5)
IOther impmvements (6) I
Total improvemenis (line 4 through lina � I(7) I I I
Total value (line 3 p�s line � (g)
1 hereby Certify the abo�e is t�ue, tOrrect. and Signa;ure of Assessor I Da;e signetl
complete.
�ying action - Sgna:ure ot Autliror I Date signed
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STANDARD DEDUCTION ALLOWANCE
t9_Pay19_ I
Lesser of 7/2 Homestead
Valuation or 52.000 5
Signamre ol Audiror Dare signed
C
Gibson County Auditor
101 N Main
PRINCETON IN 47670
1293
STATE f[iRM!1 W �R � �.NI
i
, MASURfRfORV:iI.�
fndiridual> anJ rtucrieJ toupk. are limited to onc home�tcaJ uandaN dcVu:�ion..4s ihc receip� oi �hi� Jnlucti�n bcconces
more benrficial, therc is morc incen[ive than ecer for homestead fraud IlomesrcaJ fmuJ causa hi�her tac bills tur all: theretore.
HEA 13A-i-'_fMW requ'un �a�parm who receire the hanes�raJ slandard dNuction a verify thet they am �elieiWe to mcene �h.
benefit anJ to piu�ide a4fitiunal idenut�'im_� fnWrtnanun �xcroarc m allw� counn� gw'emmm� to b:ver mmitor IwmrneaU
filim�. This in(omution will M Aryv conFdrntial and ran nnl�� h• accecsnl b�� awhar'ved rounty o(ficias. "fhe Ikryunnmm o(
I.xal Gwemmem FiRtnc< aill uss this intomw�ion �u crca:c wds �Mt a'ill h:In ��n� official> dimfiarc homcsicad tmud.
Brady L/ Robin R Havill
382 5 180 E
PrincetonlN 47670-8964
�i�n��in�i��n�n����ni�n�i�i�u���u��n��n�in����i�n�
Tasnaver Name
Havill, Brady L/ Robin R
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382 S I80 G
1
Princeton IA��7670
State Parcel Number Leeal Description
26-12-09-300-001.755-027 OOG01755-00 PT SVts 9 2 10 1 AC
C-1 j
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This form MUST be retumed to County Auditor's office. �
Please do NOT send this form back with your tax payment to the county treasurer.
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Address (dumbcr and �¢m, city, sta�c. and ZIP code)
ibe� (last 5
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Driver's LicensdState ID Nmnbcr (lu�
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!.4ddress (Number and svttl ciiy, Slale, anJ "LIP codc)
3�z S �
itturity Number (lazc 5 digirs) Dnvers License/Statc ID Ni
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pmpem addres+
Otha (pleace specif in Pan 4 below)
f
I �7�S;unc u properrv addros
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O[her (plcasc spccify in Part 4 bclow�)
undersiened certifies, under penalty of pequry�, that the abo�•e and foregoing in(ormation is we and correct and that he or she is elieible to
re the homestead standard deduciion on this property. Each undersicned al;o understands tha�, by claiming additional homestead deductions
�fully, he or she may be liable f r back taces and substantial financial penalties. I
I ttlue Dam Tclephonc " �
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