Homestead_Smith (37)/ eE �"' ; CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
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�.,��� State Form Sa73 (R2 / 5-92)
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INSTRUCTIONS: See reverse side !or /iling instructions.
. CERTIFICATION
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�e) �l �J,� �. Q /YJ/Y /v f�,(f.P ��Yf�Ncertif�gfqo'Aahe,�id 79_
n iWe) occupied a�principal place of residence the following described�ee: . '+.hSR'Si o�mesiead Pmperq���r� '� Gaimed:
� I(We) owned ❑ Are buying under contract �
❑ Have a beneficial inierest in the entity Ihai is liable for the property taxes on ihe property and thai owns ihe property or is buying under a coniract.
' CONTRACTRECORDED - '
tl buying on contract Fee Simple owner's name � - -
Recorder's oftice where contract is recorded - RecOrd number Page
� - PROPEflTY DESCRIPTION -
Coun TownsNp Taeirg -� i(ciry town, towns �
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Parcel number Legal d ri tion
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tl any portion of the residential simcture or ihe land not exceeding one (1) arse that immediatety surrounds that struciure is used to produce income, tlescribe the use and portion
of Ne property utilized to produce income. �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
� VAIUE VALUE VALUE VAWE �
Land not exceeding 1(one) acre immediately I �
surrounding residential improvemenis. (�) �-
O.herland (p�
iotal land (line 7 plus line 2� (3)
Dwelling (4)
Resideniial improvements
Garage (5) I
Other impravements (6) -
Total improvements Qine 4 through line � (7)
To�al value (line 3 p�s line 7� (g)
I hereby Certi�y the above is irUe, correct, and Sgna;ure ot Assessor Date sgned
1�mplete.
jing action - Synature ot Autlitor Date signed
79_Pay79_
Lesser of 1/2 Homestead
Valuation or 52.000
Signature
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Gibson r;ounty Auditor
101 N Main
PRINCETON IN 47670
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IndiriduaLc anJ marriN roupl� ue limiied io nre homc�teaJ standaN �4du:�ion. As the rmtipi oi ihis tlniuction hromes
murc beneficial, there i. morc incentne Oun r�er for humeiteael fraud. IlomesreaJ fiaud cau� hiehrr tac bil�s tor all: ihertfare.
HEA I;M17-3fHW requim uipa.en xho recei.e ihc hnmcste�d smndard JcJuaion tn verity ihm ihey am di;iMe m rccci.e �h.
benefi� an1 iu p(m'iJ< additiu�ul identin'fm_ infwrt�arun necrz-vey to aliw' counn emrmmrnt ro Mtirr �nuniror homes�e:rJ
filitpa-. This informaiinn xill M Aryv conlideMiai anA nn only Fc ametiad b�' aulMriud rnunn o(liciuli.'ITr Iktunnmm n(
1793 — -- - -
Cheryl Smith Etal
C/O Donna Smith
1392 S 100 W
PrincetonlN 47670-9302
�i�u���n�i��u��n���n����n�������nn�������ui��i�n����
Taxpaver Name Prnpertc Address
Smith, Cheryl Etal �
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RI f3o.c III3 ^ lJ
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PrincetonlN�7670 �
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State Parcel Number Lesal Description
26-11-13-400-001.797-027 6-07797-00PTSE �3211 3.67AC
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Owner I F'irst Middl< �� ��� ;� Lui
Che�yl �. � c�
- �g Address number on� cin. smte, antiZlP codej - - - '— — - -- ' — ' " Sume m pwperty ai.4� ' ' -" : � . . .' '- -
�� �D�IA���OO � �%i��'IG�.�UII� '-N �767D — 93oz I
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Middlc i lasc
Mailin_; Address (Number and slrttl, ciq•, 5�ale, and'LIP cak) � S:une u pmpem addr�.i
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Saial Stturiry� Numher (lut 5 digiu) Dri�xYS Licenu/State ID N�unber Qa;� 5 dieits) Other (plente specify in Pan 4 bclow�) �
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Each undersigned certifies, undzr prnalty of perjury, that the xbo��e and foregoing informution is we and cotrect and that he or she is elieible to
receive the homestead standard deduction on this pcoperty. Each undersianed al>o ur.ders�ands lh2t, by claimin, addilional homes�ead deductiens
unlau�fully, he or she may be liable for back taxes and substantial financial penalties. � !
Owner I Si¢nnWrc ,{ � Uatc Tcicphonc
,C�. �1m..z.?� ��`t a.e. � 1/�/%26io (
Spouu Sipucurc Uatc Telcphonc
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