Homestead_Blackburn s1ATE FORSI IIY+,IL'r fall T EASntEA FORM ANA
ANTI-WED BY SATE WARM'.AC011W:13.9.v MLARIBm BY i1E(*FARTHEST OF LOAF GOVELNMEFr FINANCE IC41.1.L`t1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670
Individuals and married couples are limited to one homestead sTandaN deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ma for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2000 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
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benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.ibis information will he kept confidential and on only he accessed by authorized county officials.The Department of
Local Government Finance will use this information to create toads that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Blackburn, Debora A
�(\\ 8 26 N Ilan
Princeton IN 47670
794
Debora A Blackburn
826 N Hart State Parcel Number Legal Description
PRINCETON IN 47670-1454
It IttllttTltllttlt tt��� ��t�tt�T�t�tt�tt�rt�t�t��rt r�tt�� 7t 26-12-07-102-002.970-028 019-02970-00 CHAS BROWNLEE 16 PT
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.
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
ighnI A- 4 id %3 aoiAGG,L'rii
Address(number and street.city,state,and ZIP code) me as property address
Sdo, y7. IA-17/ 54
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) / 1-1 Sem1e as property addEeas
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
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PART 3:CERTIFICATION- --- �__---. ._
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner ignature Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State �ortn Sr73 (R6 / 4-03)
Presrlibed hy Ne Departmant of Loral Govemment Finance
lNS7RUCTIONS: See �everse side hx filing insLUCtions.
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JUL 2 0 2006
i lwe) �.(�t 1�i1�. �.e, �,��D 6 1.41,P/X a'r �,v,
J certifx l�hqagt (o1n th(�e(� s��l dTay
1(We) occupied as our prindpal place of residence lhe following described real property for which a Homestea�op8rty 7# �G1Btlil
� I(We) owned ❑ We buying under contracl
20_
Have a benefidal interest in the enliry ihat is liable for ihe property taxes on the property and that owns the property or is buying under a contrac�.
If buying on conVact, Fee Simplo ownefs name
office where contract is remrded
Cou�ry
To.mship
�� �j'-Oc���O - C/U ��.��Qd �'S.?�i2�i�
If any porlian ol the residential sWcture w the Wnd nm axceedinp one (1 � acre that
of th�o� (p produce i�ome.
�
��-ia-Q � ioa-oo� 9��-��
town,
the
Record number � Page
Real property U Mobile Homo (LC. 6f.7-�
surrounds ihat sw4ure is used b produce income. desaibe Ne use and ponbn
'fz�"�r � A SESSO US ONLY��Ytz'�,� �TRUEvTAX��� ASSESSED VALUE �' HOMESTEAD'� '� NON�RESIDENTIAL�"' '��-'�
k� -`^:i� �• -a_ ..��o-,:=�-�".... ..�.:.� t% 3iVAl:UE;kv,,� � :AT-100%OF�TTV� ��VALUE�,� t . �F'i"`VALUE r+1�'' `�'�'E
z4n'?r�-k4s...,.,�,..�X:�. «.?
Land no� exceeding 1(one) acre immediately i�'� ��"-.,..'��.,.+.,E�`�` ''�° �
__.. ,�. ...,. . ., �.� .,
surtoundingresidentialimprovements (�) �....���;_�,•+"���`'K�+•..�J`-;�<
Other land (Z) =#�`�"���i x
�
'e`xv._.F�C'sc��
Tdal land (line 7 plus line 2) (3�
ti -. s ;nx.;, . "+a -� . tf�'-�,"��
� Dwelling (4) �'���.J��i�-�'r'.n+��� � ���.�k:9
�Residential improvements orMnually x . � �s'£4.
Assessed Modle / Manufactured Hatre Gara9e (5) ��:r. ' ��'x,y,' �i�` ,• x.
?�=: s���` i>,.s�'��
Otherimprovements (g) ����-�`�� �:
^..s,<:E°F" r
Tdal improvements (line 4 fhrough line 6) (�)
Tdal value (line 3 plus line � (g)
I hereby certi(y the above is W e, corred, and Signamre ofnssessor Dare signed
complete.
Verilyi(g action - SignaWre of Nitlitor Date signetl
���=��'.� k_ :"���2n�`��4s.���..���iSTANUARD': DEDUCTION'ALCDWANCE �� �'�:�?`±�„'�.i":�S'�-�"'•-'"f1�`�'e.�..i3'_"-�i'gi .'�,`�d��.`
20 _ Pay 20 _
�esser M ti2 Homestead $
Vauauon or 535.000
5'gnaWreofAuO�w ' Datesigned