Homestead_Shoultz (5)�;- CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
� State Fwm 5473 (R614-03)
.. Prescnbed by ihe Depatlment of Local Govemmem Finance
INSTRUCTIONS: See �everse sidc !or liling inshuctions.
� e' �� ? ���
NOV 05 2003
� (We) u-' certify;�ias°r52hel1s�`d Hof,Tvka � '�A.`�
I(We) occupied as our principal place of residence the (ollowing described r property (or which a Homestead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under contract
, Have a benefidal interest in the en6ty that is liable for the property taxes on �he property and that ovms the property or is buying under a contraU.
If buying on conVad, Fee Simpie ownefs name
Remrders ofice where conVacl is remrAed
Tamship
Narcel num r al descripGon Is Ne
�-n/5��� �- S S�. 3l- l-l0 , 7C
I( any portion of Ne resident7al s4uqure or Ma land nd exceeding ane (1) acre Nal immediatety wrrounds
af the proDerry u4lized to produce i�ome.
County
I hereby cer6y the above statemenls are W e, corted and complete.
(numberand sVeet, dty, stafe, ZlPcade)
County
�
■
Record number
Page
i question: Y
aeai wopeM ❑ Mobile Homo (/.C. 61.7-7)
ire is used b produce income, desvi6e 1he use and poNOn
Tavnship
;"'�+�°� ' '�'�'�'"`��������r �TRUETAXT�4�ASSESSEDVALUE �HOldESTEA��}`'z NON-RESfDENT1AL���
� F�AS5ESSOR USE ONLY �� � > s..c�: -�. � �-
�,�'�„�.�.,,�� _� , .�r�v,��;c;;���,.,� �`�VAL:UE�y,�.^ 3ATz700Ya OF�TN� «�VALUE� ����.`,. VALUE�*s.-`�`�
Land not exceeding 1(one) acre immedialety � Fi3a �.e,r�.,, �3�.'��'��-�
surtounding residential improvements. (� � :���,�Y7,'�"���,>,�,z ��� Y;
Other land ( � ��`�' � �
2 - :���-,��'
Tdal land (line 1 plus line 2) (3)
� °v-wfsxt L;t�.n � �'Ys �"� i7
Dwellin 4 �S"�-�'
9 () � ,�:�
Resi0en6al improvemenfs or MnuaAy '�� �� � !�'�'Y°�"�
'Yfi� •°P"' w'.�i*t���
0.55essed Mahile / Manufaflu�ed Hana Garege (5) ��5�, ' _ =.�h ` .� � .--�''��
'� �? � � ��'
i•.Y.�"ts�i 4
Oiher improvements (6) �< %� __; F°'t'#
? �:e�; .s.� e, .r
Tdal improvements (line 4 thiough line 6) (�)
Tdal vatue (line 3 plts line � (g)
I hereby certify �he above is W e, corred, and Signature ofASSessor Date syned
complete.
Ve�ilying action - Signature otlwEiWr Date sgnetl
/
..�s?�G+" t�+. . �"'i-:e�s*iT�T�`�4x�7�?`'�'.:i�..�`iYr�;'iv-''vr�..-.`STANUARU:DEDUCTIONALLOWANCE.,�`�$'.'�.ri�"'s�.�'£a��.�`'z��- y".'.•'�. "=:�.`°3�s`:�"c'iza4:I
20_Pay20_
Lesser of 1/2 Homestead g
vauanai a 535.000
SignaLUe of Audt« ' Date signed
Gibson County Auditor
101 N Main
PRINCETON IN 47670
f 1
� �
SlA{[ fOIIN �!KIII: / Yrvl
nRRP'EI� BY cNiE YNRD ORXR�I�Mi bm
TPfALURiRf00.4 :}1�
Indi�iJvals and marriN couplg arc limiied m ore IromeycaJ sundaN AeAu.�ion. As �hc rtteip� of Ihii deductiun bttronre:
morc benaficial, there is mwe incentnc than ner (er homnrcaei Baud. Homsttad fiauJ caust� hieM ta� Gills (or all: therefat.
H!A Ga-1-?Olq rayuires uxpa�en xho receiae 16e hanestmd <undird deAuciion m.erify thai ihey are eli¢ide to recene �he
brnefi� aN ro pnn'iJe a�ktitional iJentiirinc iniwmauun ircce.sarv to allw' cwnq� grnemmrnl to Maei mmiror homesrcad
filinp. This info�maiion xill 6e Aery mnli�iential anA can nnly F.: accesuJ Ay amMriecd munq� o(ficivi:.'fhe Ikpartment o(
I.wal Gwermn<m Pinance ��ill u.e �his in(ortnuion W create twls ihat o'ili heln covnp� offieials dimiriam homatead fmud.
_ Taspa��er Name Propem� Adtlre�s
= Shoultz, Chris W/ Debre A� i
� R3 Petersburg RU
� FkinceionlN�47670
217 1 ��j/ I
I
Chris W Shoultz
-R3..Ba�175 I15Z N ��d F�'�erS6�r.JRa StateParcelNumber LeealDescriiltion
PRINCETON IN 47670-8509 ��� —
I I II I II I III I 1 I I II I I I I I II II zs-os-si-aoo-ooi.ass-oLU ��1499-OOPTSSE 31110 .6706AC
�n u�i u�n ni u u � i uiini ini i in ✓ C-�
..—.. . —. --- _ _ _.._ ___.___ _ . _ _ _ __ __ ___ �. __— _
This form MUST be returned to County Auditor's office. �
Please do NOT send this form back with your tax payment to the county treasurer.
0
�
hri S I
Address (numbcr and strat, ci�y, statc, and ZIP code)
sa N � � ci P�� 2 rS�i
ttvrity Numbcr (last 5 dic�u) Drivcr's Liccnsc/`.
Y1 Y1
lailing Address (Number and 5tree4 riq�, smle, und ZII' cale)
`�52 N Old ��,�ers%ur RC
xial SccuriR� Number (lact 5 dieits) Drivds LiccnsclStatc ID (la,-t 5
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O[ha
S hou I�Z
�:unc as pfoprny addres�
a�,r --r �r 4�
N
idersitmed certifies, under penalty of perjury, that the above and foregoing information is we and correc� and that he or slie is elieible to
the homesiead standard deduction on this property. Each undersi¢ned al>o underslands that, by claiming additional homestead deductions
dly, he or she mqy�be�iable for back taxes and substantial financial penalties. I
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