Homestead_HerteleE�� � CLAIM FOR HOMESTEAD PROPERTY TAX FoRM
3��: CREDIT/STANDARD DEDUCTION HC10
._���� SUte Form Sa73 (R2 / 5-92)
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INSTRUCTIONS: See reverse side /or /ilrng instructions.
. . � � ` CERTIFICAtION STATEMENT �
��� e) (\ I certify �hat on the i� day of
:) occupied as our principal place ot residence the following described real property for which a Homestead Pr@{}�� Tax Rre�4'%
❑ I(We) owned ❑ Are buying under coniract
❑ Have a beneficiai interest in the entity ihat is liable for ihe propeny taxes on the property and ihat
YEAR
79_
claimed:
� - - - -� CONTRACTRECORDED � � " �
If buying on contraci, Fee Simple owner's name
Recorder's oMice where contrect is recordetl qecortl number Page
- PROPERTY DESCRIP'fION
TownShip � Ta�ting distric� (dry, fown, township)
Parcel numher L e alptlo
�o �-o �� s3 -� ��,� v✓ � 5 a �� a r�c
I( any ponion of ihe residential siructure or Ihe land no� exceeding one (7) acre that immetliately surrounds Ihal strucNre is usetl to produce inmme, describe ihe use and portion
of the pwperry utilized to produce income.
� - . PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
County Township County Township
�eby certify the above statements are true, correct and complete. Sgnamre ai n2 '/!
/ W.
Address (number and stree6 dry. state, ZlP code)
2� � pr:�c�-b SN 4�6�0
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
. VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surrounding�residential improvementa (�� �
Otherland (2)
Total land (line 7 plus line 2� (3)
Dwelling (4) .
Residential improvemenis
� Garage (g) � -
Other improvements (6)
Total improvements (line 4 through lina � (7) .
Total value (line 3 p�s line � (g)
I hereby certify ihe above is �me, CorreCt, and Signature ol Assessor Date signed
complete.
��irg action - Sgnature of Auditor - Date signed
79_Payt9_
Lesser of 1/2 Homestead
valuation or 52.000
STANDARD DEDUCTION
S
signIetl
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GibsonCountyAuditor � � � � � � �
�.� 101 N. Main Street �ndividmis and married wuplcs'are Ivnited to ane hnmcstead standard deduaion. As the receipt of this deduction becomes
Princeton, IN 47670 morc 6rnc(cial, Iherc is more incrntire itian e�er for Iwmcstead Cmud. Hamaitad fraud wuses highe� tax bills (or all; cherefore,
HEA 1345-?009 rtquim ia<pay�ers u�ho recen�e ihc homcstcad standard deducrion w�xrify chai they art eligiblc ro recenc the
0� F I I, E D brncfit and to pro.idc additional identifi�ing in(ormaoon necessary �o cllow' counry gatmmcvt to btacr moniror homestead
filings. "Rtis information xill be kept wnfideu[ial aod can only be acttxud W aut6orized counry officials. The Department of
I.ocal Gmxrnmrnt Finance w�ill use Ihis info}maiion m create [ools �hat will helo counN officials elimirete Mmestead frzud
MAY 16 2011
- C.'�.n�
— GIBSON COUNTY AUDITOR
Taxoaver Name Location Ad
Hertel, John W/ Gina M
�/ o
/\ PATOKA IN
447
John W/ Gina M Hertel (I�I�III��III ull �I �III �II I��III �'�II�II��II�II�III �II�I�II�.
3087 W 50 S
PRINCETON IN 47670-8129
I�dI�i11��iI1�I��1�II�III�II1�Li��lu���u��ili�u��il���n��ll StateParCel Number Leaal D
26-11-15-100-001.653-02�PTENW 15211 2
This form MUST be returned to County Auditor's office.
Please do NOT send this fo; m back with your tax payment to the cou
�ol��.
W�11���
I-�-e r!-�l
ailing Address (misba end sim�� ciry. stau, and Z[P code) . . �ame as property addxas
3 O�i% w's�5 ���v� c2�o,� .=N L('7� `7p
rcial Savrin N�ber puz 5 digia) Drivets LicensdState ID Number Qazt 5 digiu) �. Other (plcax specify in Pan 4
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OLLSC
G;�a
ji�ing naaress cNumber aua�ureet, ci
cial5ccurity Number (la5t 5 digiu)
= �5�
1-�-�e' 1 �-e. �
in Pazt 4
undersigned ceriifies, under penalty of pepury, that the above and foregoing information is We and correct and that he
•e the homestead standard deduction on this property. Fach undersigned also understands that, by claiming addirional
�fully, he or she may be liable for back [axes and substanual fmancial penalties. . -
I Signaturc'/�/� /� � /��l � / �y 9 a TelepCane � - � �— �
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