Homestead_Rainey (3)�f R�3
a! °, CLAIM FOR HOMESTEAD PROPERTY TAX
3���� CREDIT/STANDARD DEDUCTION
���� State Portn 5473 (R2 / 5-92)
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INSTRUCTIONS: See ieverse side lor filing instruclions.
" FORM
HC10
�Y
i"ve)L�J Va� V / V.,JL/ / certify that on the 7st day of March, 79
��) occupied as our principal place of residence the II wing escnbed real property or hich a Homestead Property Tax Credit is hereby daimed:
J I(We) owned ❑ Are buying under coniract .
❑ Have a beneficial interest in the entiry ihat is liable for ihe property taxes on the property and that owns the property or �il� tl�tler �tl�t1
� � CONTRACT RECORDED . �
It buying on contracL Fee Simple owners name � � ' .
Recorder's oHice where contract is recortletl Record �y
AUDIT R'
County
tl any
of ihe
PROPERTY
Township
Taxing
ber��� � Legal description � Y
� ��_o
m of Ne residential simcmre or the land not enceeding one (1 � acre ihat immediatety surrountls that swcture is used to produce income, desaibe [he use and ponion
arty utilized m produce income.
ASSESSOR USE ONLY � � VALUE� � VALUE V vVALUE�� �V � VALUE ��� �
Land not exceeding 7(one) acre immediately
surrounding residential improvements. (�)
Otherland (p)
Total land (line 1 plus line Z� �3)
Owelling (4)
Residen�ial improvements
Garege (5)
Other improvements (6)
Total improvements (line 4 through line � (7�
Total value (line 3 p�s line 7) (g)
I hereby certify the above is Irue, correct, and Signamre of Assessor Dare si9netl
complete.
�fyinq action - Signature ol Auditor Date signed
�
19 _ Pay 19
Lesser of 7/2 Homestead
Valuation or 52.000
STANDARD DEDUCTION
S
Signature of Audimr A1 ,{ \ . \/�/� I uate S�n-a �_��
ii r� � l� �� �� ,Q ,� /�_J /
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
2228
Charles M/ Amy S Rainey
1094 E Taftown Rd, �
PrincetonlN 47670-8603
ncr 1
Clt a r �CS
,
5�>iEl00.\I � 1K�IC'/ ��MI �MASUIlA PoRV'�]Z�A
.V�RmfPl�l'SHTEM�R�tKM'��ITSb�M p4fY(W�FnPYi�llDEPM1MI.V�(KL(6AlG(hR6VNG.TFdn]CFICLI.I-S-�.I
hidicidual.. anJ innrriN mupks a�c limited �o nne home9caJ vandaN dnluction. As �he reccip� of this dNunian bccomes
mere beneficial, therr is more incrnme than e�er (or M1onmieml fnuJ. Homrseml f2iu1 causcs higher tai bills fur all: therefae.
HEA Iid3-?OQ9 requim uapa.en rho rceire ihe hanes�eaJ standard dNuction m.erity thai the. art cliciMe io mcei.e ihe
benefi� ani w pnn'ide a�4litional iJenifirin_ infwmaron riece.sary to allw' aounn gmrmmm� tu betrcr�monitor humeste:xl
filin�,�.. This in(ormation w�ill M Arya ttuifdcmi:d mA nn nnly h: avicesscd M1y awhnriieJ counp� otT¢inL..'Phe Ikpanmrn� nf
Iwal Gmcnvncm Fivncc will mc �hia iniomueian m ucatr «�uLa tiut x�ill hdn mum� olTiials dimiiuie homesmxl fraud.
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ig AdJr<m (nw�iuu uiu 3u.x[, iity.-.wm, wd ZIP.od-i'
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_ Address (Numbcr and svttt ci�y, staie. and "LIP cak)
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c prop�m od�=.— - —.
Oiher (plcsse specify in Part 4 below)
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p��,y aadre�
speciF in Part 4 bclow�)
Each undenitmed certi6es, under penalry of pequry•, that the above and foregoing information is we and corrzct and that he or slie is eligible to
receive the homestead standard deduclion on this property. Each undersigned also underslands that, by claiming additional homestead deductions
unlawfulh�, he or stie may be liable for back ia�ces and sub+�antial financial penalties. -- -- ----- -- - -� I � -- -
Date
y 9- � o
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