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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
s.a+e w�m s�r3 crn i so�
~ P-ewi6M by tl�e p¢paM�ent af Loml Goverm�q Fuvnoe
wsraucnorrs: seer���:bero.m�ny;�so-�cao�.
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FORM �R
HC10
�(We) _`, L.C./n,a'�"'T„d .f'1► i� l n , ceAify fhat On tlle 1`5f day�'AA'��tl1�2(�'_'� 1
I(We) ocwpied as av pimapal place o; ; esidence fhe fcflowing desr.n'6ed rea ,riy fnr whiqi a Hanestead Property Tmc Credit i$� �E daQirtied:
�� �(We) owned ❑ Are buyug under oontraG U� l. � O�oos
Have a benefidal interest in the entity Mat is liade tor the propeAy fazes m the property and Mat owns tlie property or is buying ua�er a conh�yi�,
rc buy"sg om m�traG. Fee Sirt�le ornefs nart�e. ..
ftemdefs dfice whae mrmad is recaded
Canly Turr¢tup
Recad number Pege
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�o� 0�3��-0o I`�.�`�lq-a�o .,. ��� o��� o����,.�.�,.,_�
n arn Porta� a uie icsidenUal strueue v me Im,d na� e�eeiry a,e (1) aQe aiat :omeaa�ey a,noim�ffi a,� mwve is u�d m v�+�e :imme. dea,be u�e use and pation
oi Ure popaAy W6zad m omM�cn u�mne. � a` •-
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�Q� � aG-�a-�9-ac� -�o� 3ir-Oa �
" :, � .'i--:,' wiorarrr ovrNm er cwa��wr a oni�x courrt�s -. :,; . . .
County TanshiP County Towns�ip
� hefeby oertiry a�e anove shaterrrsts are we. c«red arid crnrq�ete. � a �ma�a
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(nuMer entl s6eeL o11: �aro. ZIP code) '
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. . . , , . . . ,, . . . - �r '� }.`TRUE.TAX . ,�. �ASSESSm�VALUE .;`HO�STEAD" � �NONiiESIDQITIAL
. •�0.SSESSORU5E�ONlY� �� . • . .
. < . >.�k: .,= i VACUE;-.� `+AT700X'OFTTV . ` VALUE -r.-". � .,.:�:.; VALUE-.��.
L�d not esceedi� i(me) aae irm�e6atety — - - �' -
siarounding2sidentialimpovements. (7) � ` ,.'.,- � �:
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Otherlard (p� .
Td� land Q'v�e 1 plus fne � ig)
Resdential irtiprovertents a Mrwally �6� �4� '' �n � :-`� � : �.' �
Assessed Mlohae / Maraifac�ed Hartie �n r
Garege �5� r � _ � � :
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omg �.�� � �s� I , .;, ` ° ' �'
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TUaI'vnprwemertls (6re 1 fhro�yh Ifne B) { — I..._
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Titel value (!ure 3 plls Gne � � ig) I
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I Fiereby certiy tlie ahwe is true. oortef3. and Isg^�+e otacvmwr nate sy�ed
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�M^8 adion - Sigehce ol Ndio� Dsh+ s.p�M
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20 _ Pay 2(1 _
Lesser of 12 Homestead
Vahiation m f35,000
Si{�ahaa of Ni&M
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SfATF fORM 515M(YJI &10)
APPRq'ED BY ST�TE B W FU � A('COU`f�S Z A9
rnEYA�B�D BY
iFFASLAFAiORMTSI�
Gibson County Auditor � � � � � � � � � �tl�iiii'�
101 N. Main SVeet �ndrvfd�Is and married muples are limited b one homcstead standard deduaioa As the rcceipt of this deductian 6emmrs
PfInC2tOn, IN�47670 mom beneficial, �herc is more incentive chan ner for homrnead (aud. Homcstead Gaud cauus highe: �ic biils for ell; ihere(ore.
� ' HFA 13J4-?009 requim Ia[pa}ctt who recei�x �he homestcad sfmdard deduccion m vtrify tltat thc�� are eligible to rccei�c Ihc
bcncfit and to pro�ide additionai idrntifi�ng informa�on nccessery to allow couny Ewemment to.bettcr moni[or homestend
����T filings. 7}tis in(ormation will 'x kept confidential and can only be aacssed by au[horired wunly olTicials. The D�parweot af
, B Local Grn'emmrn[ Fiunce will use �his infortnation m crtatt [ools tha� witl help cmmry� officials climinate lwmestad fr.ud.
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— APR 14 2011
_ C.'J.
1402 GIBSON COUNT�TOR
Randall A Scales Jr.
252 E 200 S
� Taxpaver Name -
Scales, Randall A Jr/Mela�+ie�R
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II01 �I I I� �III �I I�I �III �I I
Location Ad dress
252 E 20D S
PRINCETON W-07670 .
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I� II I 01101 II �II �III �I II� II�I �I� III III
PRINCETON IN 47670-9262 `
���I�I��"�����'��I��'��"��I��"��'��I�'I�I�II��'�I��I�"'�III�I State Parcel Number Leqa1 D,:scription
2612-19-200-001.311-027✓T NE 79 210 2.0o P.0
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This form MUST be returned to County Auditor's office.� �
Please do NOT send this form back with your tax payment to the coun�ty treasurer.
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Add�ess (¢�ber end stree4 city, sta[e, and ZIP code)
S�2 C 2�0 $ �i2 1.
cial Sccuriry T�ber (lacc 5 digics)
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O[her (plcase specify in Part �bclow)
undersigned certifies, under penaliy of perjury, that the above and foregoing information is We and cortec[ and that he or she is eligible to
+e the homestead standard deducrion on this properry. Each undersigned also understands that, by ctaiming additional homestead deducrions
vfully, he or she may be liable for back taxes and substantial financial penalties. " r �
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