Homestead_WaldroupC J
Gibson Counry Auditor
101 N Main
PRINCETON IN 47670
655
Anita J Waldroup
1367 N SR 65
PRINCETON IN 47670
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L�dividuaL anJ ma;ried <nupla are limimd to ore homz�eaJ �tandaN Jedunion. As �he �eceip� oi this Jcvlunion bttome�
mere brnefi<ial. thrrr fs morc i�rntke than arr for hort¢sread Gaud. Homri�eaJ fraud cau�es hi�her Iaa billi (,nr all; thercfae.
HE.\ 13�-?O(19 requim �aqra.en atn� receive �he hanesirad sundarJ deJuriion io reril4 �hai �M1ey am <IigiNe io recei.r ihe
bencfit anf to p�a'ide a�kiiiional idrntifrim_ informauon necr<'vn �a alluw� rounty gmemnem to berter moni�w IqmeseaJ
Blim�. lhis inlarma�ion will br 6ep1 conf.cemiai and can nnl)' f+c acttsseJ hy aWMrized tomu� nlTitiols.'ILe lkpan��m1 nf
Local Gmammem Financ< ��ill uxe this iniortnation w arratt [ouls ihat will help tuunq� otTiciaL. dimiwrc IqmestoJ fiaud.
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Taxpacer Nnme Propertc Address
Femp}-HB�eFfr'
/�n,�c.. Tl.Jalelrov..p a���3�.�ay
Prinn�on IN 17670
State Parcel NumAer Leaal Description
26-12-06-100-001.928-0 0060192a-oo PT NW 6 2 10 1.0762
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.
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Ou�ner I � First M1tiddle j Lazl
�/�i//3 ����. A�df���
� g Address (number and i�reet, city, sm�c, end ZIP code) �$ame as pmpeny oddres.
`}�� �� O X �� 7 7
Social Securily Numbcr (las� 5 digiLS) Drivei s License/Slate IU Numbrr ps,i 5 disils) Oiher Iplcace specify in Part 4 below)
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Spouse Firs[ MiJdlc Last
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Mailine Address (Number anJ slrce4 cil}t siale, and ZIP cuJe) �$ame u pmpeny adJrts�
Social Stturiry Number (lacc 5 digi�v) Drivds Lice2�rJStarc ID Num�r pa;t 5 digitsl Oiher Iplease>peeiF� in Pan +below)
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Each undersigned certifizs, under penalry o(perjury, [hat the abo��z and foregoing infortnation is we and correct and that he or she is elieible to
receive the homestead standard deduction on �his propeny. Each undersignzd also undersiands that, by claiming additional homestead deductions
unlawfully, he or shz may be liable (or 6ack taxes and substantial financial penalties.
Ou�ce�r $igna[ure Dste 7'dcphonc , /
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Spou;eSignamrc Uate ielcphonc
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