Homestead_LaGrange'� � .. .
. SiATE FORM 5)SM (IU/ &�%
I4FA5�'RFII f00.N TSIA
Gibson County Auditor � � � � � ' • ' ' [�I1�aY�
101 N. Main Street �ndividuals and married muplcv are limited to one homcctead standard deduccion. As [he receipt o1,'this deJuctinn becomes
PlIf1C2iOn, IN 47670 more 6cneficial, ihcrc is mwe inttnti�e IFun aer for iwmatcad faud Homestrad faud wuses hightt taz bills for all; lhert(orc,
HEA 1344-2009 requires taxpaycrs who rtxei��c the homestcad standard deduction to �rrify'hat thcy:i�s eligibk ro receicc the
� F I L E I� �efit and W prmid< additianal identif}ing infomution nccessary w ellox county gmxmmect lo tKttcr monitor homcstead
filings. 7Ttis infortnacion w�ll be kcpt conGdrntial and can onN be accessed by authorized counry of5cials. Thc Deparm�ent of
I.ocal Grn'emmen: F�ntt will use diis infomialion ro cmatr tools that wiil help counrv officials elimi�ate tromestead Raud
APR 2 6 2011
C.'�.n�
� ' GIBSON COUNTY AUDITOR
7248 .
Thomas LaGrange
991 S 250 W
PnncetonlN 47670-8172 �
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Taxpaver Name
LaGrange, Thomas
/
II�I �I I I�
99t S 250Iw
PRINCETON IN 47670
II�III �II�I�IIIII�II �Ilullul�l� II III
State Parcel Number Leaal D
26-11-14-100-001.934-02�PT NW 14 2 11 4.6
This form MUST be returned to County Auditor's o�ce.
Please do NOT send this form back with your tax payment to the cou
ailing Add[css (number end sucet, city, statc, and ZIP codc)
�-1 � . 7lJ' ��. { 1"��
�cial Security N�bcr (last 5 digitt) Driv �s Liccnsel',
.� .� � / _
Addr¢s (\umber and strce4 ciry. smte, and 7_IP code)
N�bec (lazi 5 dlAts)
ID Number (lazt S digits)
�
Same as ProP�rtY
in Part 4
_�.
���
Other (plcase speciry in Pan
D-17
r treasurer.
Fach undersigned certifies, under penalty of pequry, that ihe above and foregoing infortnation is we and correct and ihat he or she is eligible to
receive the homestead standard deducrion on this property. Each undersigned also understands that, by claiming additional homestead deductions
unlawfully, he or sbe may beliable for back taxes and substantial .`mancial penal[ies. �— -- - - __.. _,_� ._
Owntt 1 Signat�ue Date Telephone
-._--,;� �. r� �_�`� ---- �%..i„ (��
-
N �`"� YEAR
,y t CLAIM FOR HOMESTEAD PROPERTY TAX FORM
�� `: CREDIT/STANDARD DEDUCTION HC�O
• State Form Sa73 (R2 / 5-92)
�� '�i � .-_
INSTRUCTIONS: See �everse side lor7iling instructions.
I(We) \// � . `, �� certify that on t��t d4yLOf �M c,Fy7, 19_
1(We) occup ed as our principal ptace of residence the tollowing described real properry tor which a Homestead Pr ny Tax Credit is h/e���rclaimed:
'� I(We) owned ❑ Are buying urMer coniract �//� /]
iil4c.,... /...IN�'. // /
Have a beneticial interest in the entity that is liable tor the property taxes on the pmperty and that owns the property�or.is buyirig unde�a-contraa�
- � � - _ CANTRACT RECORDED' '. - ` -- � ; _ -
If brying on contraa, Fee Simple owner's name
Recorder's oflice where contraa is recordetl Record number Page
County
P nu ber n
��
If any portion of Ne resitl
of the DroceM uGlized to
Legal
structure or the la(W not
ice income.
-�� . . . PROPERTY DESCRIPTION ° - .... -.> ' - -. ..
Ta�cirg di ricl � f ;to nship �
� L� .
P�,o� —� —// . /��
ce mg one (1) aae that immetliate surtounds that structure is used ro produce income. descdbe the use arW
- ASSESSORUSEONLY - � TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIALu
� ,. � VALUE VALUE VALUE VALUE � -
Land not exceeding 7(one) acre immediatety � � . ° �
surrounding residential improvements. (�) `� ���
Oiherland (p) _ `��'
Total land (line 7 plus line Z� (3)
Dwelling (4) � , � , � • .
Residemial improvemenis , '
Garage (5� � � "
Other improvements (6) �
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g�
I hereby certify ihe above is IrUe, correct, and Sgnamre of Assessor Date signed
complete.
Veritying action - Signature of Auditor Date signetl