Homestead_Saylor- n ' .. � . . . _ ._
t CLAIM�FOR HOMESTEAD RROPERTY TAX
CREDIT/STANDARD DEDUCTION �
\ State Fwm 5473 (R6 / 4-03)
' Prescribed by Ne Deparonem ot Lacal Govemment Flnance
INSTRUCTIONS: See reverse side /or �ling instructions.
�� FORM
HC10
YEAR
.:]"'+:?�^-Yww4zw "�: °�.?�'t�P.3:i.Z++"�.E'��r. ` �%-'�;+Nir �?..+�i.v.F',�:GE FICATION'STA7EMENT�..."� .. x: .�.•.1L/.:' .
I(We) certify that on the'iSTday,of,Ma�Q�_
I(We) i s our prin I place of residen e follo � g desc ' ed real property for which a Homestead Property Ta�c—Cyr,e,dit is hereby daimed:
I(We) owned ❑ buying under conVact p�(� ,��,j{���
Have a benefidal intarest in the entity that is lieble (or the propeAy taxes on Ne properry and that owns Ne prop�9@T1�p�y��r�era'mnlrOR
AUDIT
If buyinp on contract, Fee Simple ownefs name
Retordere olfice where mntraq is recorded
� r>';,ss^�i�+�.�`�i;'r�-�'°-�'xC'r-�,,.���`'�`k �,��.`x``�..
Counry Township
. .�. .. ;03
If any pottion of Ne resic
d Me property utlltred ta
O�I Legal description
cr
ne w the land not exceeding one (7 ) aae
ome.
I hereby certlry Ne above statements are We, cortect end complete.
Lend not exceeding 1(one) ecre�immediatey
surrounding rasidential improvements.
Otherland
T[tal IarW (line 1 plus line 2)
Residential improvements or Annually ��ling
Assessed MoWle / ManufacNred Homa
Garege
Tatal improvemenk (line 4 through line 6)
Tctal value (line 3 phs line n
1 hareby certify the above is W e, correU, and
completa.
20 _ Pay 20 _
Leuer of 12 Homestead
Valualion or $35,000
S.1lb�
� TRUE TAX�+�y��
'�� : V/1LUE;�.?:.'F"�..�.
(�)
i2)
(3)
(4)
(5)
(6)
�)
(8)
SignaNie of Assessor
5
Rewrd number � Pega
lha properry in Questlon:
I Q.Real property ❑ Mobile Home (I.C. G1.1-7)
surtounES Nat sWCWra is used to produca income, dast+ibe Ne use and portion
�
tc ..
�
signed
signed
_ , < (: :`� - '
;g.°�! � fi °i
�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
I111
TPfA511Af0.W0.4:3�A
hWividuals and nu:riN coupk. are Iimi�N to onc hnm�eaJ �andaN JeAuninn. As the �ttxip� of �hi:: dMunion Mcome:
more beneficial, therc is morc inernme tkm ncr (or homes�ead fr.md. Ilomes�eaJ frauJ caus�s highrr tan 6ills (or all: therefae.
HEA 13i-1-?(NW mquirn uapaccn who reeeivc Ihc hanesteaJ >mndarJ �kriuciion w.eril'y dat thry are eliciNc io rccei.c �he
benefi� anf to pnw'iJe �AAl11UNl idenufrmc infwmarion �mrvn' ro allw� rwnn� gmrmmrnt tu Nner muniiur hamcs�eal
tilin�,�_ Ihis inlmmmim x�ill be I.qw confidttuial and nn nnly h acm.eJ M1y amhoriecJ rouniy oficiuLs, Thr Ikyunnrem nf
I.r.�l Gm�mmm� FivMe ��ill u.e chia infnrmacion �n ercam t.ols tlut will hcln cvmn� ulTirial. eliminarc hume�icmi fiaud.
Jerry A Saylor Jr.
1221 W 150 S
Princeton IN 47670.9307
���n��ui�i��n�ni���n��i�nn�����ni�ui�n���n���i�n��
�
Trzoaver Name Prnoern• Address
Saylor, Jerry A Jr �—
RI 6ox 10
�
c�o�47670
State Parcel Number Leeal Description
26-11-24-100-003.557-0 006-03557-00 PT NW 24 2 11 1.39 AC
� �111�,,�
�ueaY, <ity, smte, anH ZIP code} � - - � ' — - - --
Ira-� S �r��e-d�w�- .9�C �l
digin) Ihivers Licrnu/5tete IU Nmnber (la.t 5 digits)
ng Address (NUmber and stree4 d�y, staie, anJ'LIP cuJe)
IZ'z\ U� 15o S Qc�n�
,
undersitmed certifies, under penalty of perjury•, that the abo�•e and foregoing infortnation is we and co�rect and that he or she is elieible to
:e the homeslead standard deduction on this property. Fach undersiened also understands that, by claimin¢ additional homesiead deductions
,-fidly, he or she may be liable for back taxes and substantial financial penal[ies.
� sienzi�c o`L ro�cpnon�
�� �