Homestead_Jacobus,,....,,
a i CLAIM FOR HOMESTEAD PROPERTY TAX
���� CREDIT/STANDARD DEDUCTION
.;.�l�., State Porm Sa73 �R2 / 5-92)
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INSTRUCTIONS: See reverse side lor7iling instructions.
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I(We) ( c�rtity that on�the �1�t day of ar . 79_
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'�) occupied as our principal place of residence the following escribed real property for which a Ho �je�d�,Prop_�a.r�y�T��Credit' claimed:
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L� I(We) owned ❑ Are buying under coniract
❑ Have a beneficial interest in ihe entity that is liable for ihe property taxes on the property and that owns the property or is buying under a contraci.
' -� � - CONTRACT RECORDED - '
If buying on contrad, Fee Simple owner's name �
Recorder's oHice where comraa is recorded . Record numher Page
Counry
Township
Ta�cing
Parcelpµ`9pgr� ' �0��� Legal description '' )' • ^ � � � . /7 � / �
v`�6 H l/ J a.l -�- ',
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II any ponion of the residential stmcture or the land not exceeding one (7) acre that immediately surwunds ihat swciure is used to produce income, describe Ihe use and portion
of lhe properry utilized Io produce income.
Couniy
PROPERTY OWNED BY CLAIMANT IN OTNER COUNTIES
Township Counry
�eby certify the above siatemenis are irue, correct and complete. I S�i�n�,r � ci� am
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ary, sfate, ZlPCOde) d
. 13�t �"3 .. �'Inc�ce.�,G 9,-, v767c
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL �
- � VALUE VALUE VALUE VALUE _
Land not exceeding 7(one) acre immediately
surrounding resideniial improvemenis. (�) ��
Oiherland (p) -
Total land (line 1 plu5line Z� (3�
Dwelling (4) . � - �
Resideniial improvements
Garage (5) -
Oiher improvemen[s (6)
Total improvemenis Qine 4 through linz � (7)
Total value (line 3 p�s line � � �g)
I hereby certify the above is [me,-correct, and Signature of Assessor . Da;e sgned
complete.
Veriying aaion - Sgnamre ot Auditor Date signetl
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� - STANDARD DEDUCTION ALLOWANCE � ' � '
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000
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Sign tur otAuditor Datesign
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
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�1 V E fORM!).'M IR_ /!�NI
lnJfciduaL anJ mrriN couple. are limi�ed io ore hamcucad .tandaN �h�lunion. As �he reccipi o( �his dcdunicrn Fecnmc
mure bcneficial, there is more mcenmx than r�er (or home>teazl fnud. Ilome,�ead fr�ud causs higM ta� bills fa all: thrretue.
HEA 133A-?fNW rcquim u�pa�m v.iro rccci•e ihe hanesicaJ smndard �hluction m vrri(y ifut thep are el SiMe io rccei.c �he
benefii amf ro pnn�idr a4litional iJrntiiyinc infwm,rown nctic�vn� to allw' counn' ernrmmem ro Nnrr mmlwr honxsrcaJ
filin��_ This inl'mmalinn will br At�u canlidenlial anA nn only fn acrex�eJ M1y awhnriuJ count�� oflicials. `fhe IRpanmenl of
Lucal Gncmmcm FinaM'< wdl u.< this iniormatfon w<rcah 0.vls Out o�ill h:ln camrv oSKtials dimi`aV- hancsrcaJ tnud.
1092
Robert H/ Floy Jacobus Life Est .
2058 E 250 S
PrincetonlN 47670-8725
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nddress (numbcr ena snttv. ciry, sta�e, anti ZIv coue)
Tazpa��er Name
Jacobus. Robert H/ Floy Life Est Elal
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Securily Numba (hst 5 digits) Driva's Licenx/Sute IU Nmnber Qazt 5
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Address (Numbcr anJ slree4 cin', sWle, and "LIP cu�k)
Numbcr (lan 5 digitt) � Drivcr's Littnsd5ure ID Numbcr (1azt 5
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R2 13or
Princcton I\
State Parcel NumAer Leoal Descriolion
26-12-21-4� 000.985027 0.�000985-00 PT SE i1 2 10 5.8311 AC
TAco 3us
2 a, s.� � 3,
� Same us propeny addras
Mbw l
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undersigned certifies, under penalty of perjury, that the above and foregoing infortna[ion is we and coirect and [hat he or she is zlieible to
+e the homestead standard deduction on this property. Each undersigned also understands that, by claiminc additional home;tead deductions
��fully, he or she may be liable for back taYes and substantial financial penalties. I
� 1 SiFnnturc Datc Tdcphcmc
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