Homestead_Carey (3)a.��� CLAIM FOR HOMESTEAD PROPERTY TAX ' FoRM I YEAR
Si�': CREDIT/STANDARD DEDUCTION riCio
�.� State Porm 5<73 (R2 / 5-921 �
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INSTRUCTIONS: See �everse side loililing instmctions. _. �
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CERTIFICAT�ON STATEMENT
��We) certify th +� o � � oi� c�_
��) occupied as our p. ipal place esitlence the follo g descri ed real pwperty f which a Homestead Propeny T��'� y claimed:
(_,�) owned ❑ Are buying under coniract
❑ Have a beneficial interest in the en�iry thai is liable for the pmperry taxes on the property and that owns �he property or is buying under a contraci.
CONTRACTRECORDED
It buying on con;ract. Fee Slmple owner's name
flecorder's o"�ce where wmraa is recortletl Rxortl number Page
PROPERTY DESCRIPTION
County Township Taq+g district,(city. (own. township)
Parcel number � Legal tlescripiion
V I �— V l � U't — Ll_) I
I: any portion of ihe residemial stmcmre or the land not e.ceedinq one ( t 1 aae that immetliatety surmuntls that stmaure is usetl to protluce income. tlescribe ihe use antl ponion
ot the pmpeny utilized to protluce fncome.
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immetliately I' � I I I
surrounding residential improvemen;s.
Otherland �z) .
Total land (line t plus line Z� (3)
Dwelling (a) ' I
Residential improvemenis
Garege I (5) I I
Other improvemenis (6)
Total improvements (line 4 fh�ough lina � I(�) I I I
Total value (line 3 pfis line � (8) I I I
I hereby Ceriity �he abo�e is �me. correCt. and Signature ol Assessor . I Oaie signed
complete.
V�erilying ac�ion - SignaNre ot Autliror Date signetl
STANDAHD DEDUCTION
19_Pay19_ � ,
Lesser of 1/2 Homesteatl '
Valuation or 52.000 S
SignaW�e o�AUtlitor
Dare
^ � v �
Gibson County Auditor
101 N Main
PRINCETON IN 47670
1$74
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�I.F3AIBm6Y
TRFASI:�.FRRM4IIA �
IndiriJua� anJ tmrriN roupk< are Iimiied io onc hnm��esJ �andaN �kdunion. As Ihc teceip� of Ihi> deduction becomes
mere benencial. �hrre i� morc incen.ne dun e�er (or homn'tead &auJ. Ilomesrcai f`awi cause> h�htt �n bill> for all; ther<fae.
HEA 1i�17-70W requirts uapa.en xho rc�ccirc ihc hannteed sundard �viunion in verily �M� �hey are eliciNe �o recene �Fe
benefi� aN io pnw'idr aikfitio�ul iJrntiiyinc infwmatfun nem'vn ro allw� counp' gmrmmrnt ro Hner monitor homauaJ
tilin�n. Ifii� iniormminn will be F.ep mnlideminl anA nn oNy M arce: �ed Fy amhnriznl rnuny� o(ficial�. lTr Ikpanmem nf
Lecal Gwvmmrn� Fivnce aill mc thfs iniorma[ion W cream Wols ihat will h:Ip �ounn' officials climinaie Ipmc>t<ad fiaud.
• • � � �
Ta�paver Nnme Propert�• Address
Carey, Roger Lloyd / Jamie Jo
510 Clcvcland A\'E
Princeton 1\ 47670
Roger Lloyd / Jamie Jo Carey
510 Cleveland AVE State Parcel NumAer Leeal Description
PrincetonlN 47670-2908
IiIuILuIiIInIu�Illinnlill�InlLnlulinillll�nilL�I k 26-�2-�8'301-001.904-028 Bi9K-091904-0OBALDWINHGTS tOpU11/72
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
and sviceL ciry, sure, and ZIP code)
Sume as pmpem ndd�cv
Securiry' Number (last 5 digits) � Ihivas LiceRac/Statc IU Numbcr (lazi 5 di�its) � O�hcr (please spaify in Pan 4 6elow)
e.4ddress (Number and Arce4 cit}', Slnle, and "LIP code) IGi $ame as propmy address
LJ
\O � . c� `-�
Saurin� Number (lact 5 digi�s) Driver's LicensefSlatc ID Niunbcr (la,� 5 dieiti) Other (plci5c s'pccify in Part a bclow)
` _ sux� `�
undersigned certifies, under penalty of perjury•, that the abo�•e and foregoing information is hve and correct and that he or she is elieible to
�e the homestead standard deduction on this property. Each undersigned also understands that, by claiming additional homestead deductions
rfully, he or shz may be liable for back taxes and substaniial financial penalties.
I gn e Datc Telephone
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