Homestead_Christmas (5)taHta ¢ w is�z . , . , .,,
PrtunOtO By Slale Bw�O ot 7a� Commissionmz
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19�— ��
. SEE BACK FOR FILING INSTRUCTIONS � o�9_�yo��-oo��:.
� o� k/"l�tix� ` 2- �e ���'!.�-Z»�.s�J certify that on the tst day of
h�n, 19 �I�I, fWPI occupied as our orin oal olace of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) � owned
O are buying under contract � _
❑ have a beneficial intere t i�axpayer �
Property Description in County , Township
Taxing District (City, Town, Township): ��+��-��
Parcel Number � or legal description shown on tax statemeni:
. /�, �. 9.i .
If buying on contract: Owners name ��� simole
Contrect recorded in Recorders Office - Record No
If any portion of the residential slrucWre or the land, not exceeding one (1) acre lhat immedialely surrounds that
structure is used to produce income, describe ihe use and portion of the property utilized lo produce income
Any other counties in which individual owns or is buying real property:
reby certify the above statement is true, correct and complete.
AOOi¢ss
County Township
����.,�. �76 7a .
.. GnY. Staie ana Zio CoOe
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
� ����F. ��ASSESSOR'S USE ONLY -
r�AY i � 1�A�
Land not exceeding 1 (ona,�c�;,��iayQly�S
surrounding residential improvem�,s�t �TOR �
Other Land
Total Land
Residential Improvements
Dwelling
Garage
Total
1�)
(2)
(3)
(41
(5)
(6)
True Cash Assessed Homestead
Value Valuation Valuation
Oiher Improvements ���
Tot�provements - Line (6) plus p) equals (8) I8)
I he�euy certify the above is true. correct. and complete._
Slqnawre ol Assessor `
- ACTION BY AUDITOR -
Aooroved: �""""" N ' - ° S
�
� �
o:,i��
Date:_ �//9�8%
�
Gibson County Auditar
101 N Main
PRINCETON IN 47670
I nrASUUxroxv;i�n
PA[YRIBm
Indn�idua� and mt-riN coupiec arc limittd io onc homcue�J �undaN iL-Amiun. As �hr �eceip� of this dNunion bttmre�
merc bene5cial, thzrc is morc incrntne than e�er for homc7eaJ fr�ud Home�ttad fiaW auses higher n� bills (or all: thercfoe.
HEA G7-i-?W9 requ'ucs taapasers v.ho recci.c iM1c hanes�ceJ sundard dNuaion w verify �ha� they art eliciNe io mcenc ihe
benefit ani m p`p�ide additiuful identiiyint intumunon ntt�c:-vn� to allw' counq� em�emmmt ro betmr moniror homcs�eaJ
filing.. lltis in(orma�ion vill be F.ery rnnli�icniial mA nn oNy Me avmsseJ 6r amFwr'vnf county ofixials. T6e Ikrannxnt nf
Iwical Gm<rtmrcm Fiiu�rce x ill u�c Ihis iniortnation W crcam twls �hat wfll h:Ip cwnn� offcials climinatc M>mc9cad fiaud.
Taxnecrr Neme
Christmas, Dorothy Life Est & John C
SD
1464 �•� �� � � ��
DOrnf I Chrf<r.o�<
307 E Monroe
PRINCETON IN 47670-2411 State Parcel Number
I�I��II���I�II��I���III„�„I�I�I��I���II���IIII���I�„I���III 2s-�2-i8-201-000.401-028
_ _ —_ _ ._ _ __._ '_ __ _ _ — � __ . __._-_
Propertc Address
933 5 Gibson Sl'
Princeton I\ 47670
Leoal Description
019-00407-00 SS ADD 95
This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
�� �
Ow�ner I First Middle Lati
7�NN ����- C�i�q,�sims�s
ng Addr�s (numbcr and >a«v. cirv, sea�c, end ZIP code) umc ns propem addres,
7U % S v r.� / Yl �' �� S o/� S I. �' �' /y C e j o/Y ZG✓.s/J�7v
$ocial Sceurity Number (last i digits) Driver'
Spou e Firsc Middlc Lau
Mailine Address (Number and sveet ciiy, sWlc, and "LIP wile) � Same u pmperrv address
—T"d .N
Social Stturiry� Number (latt 5 digits) Dnvers LicensdSUte ID Nirtnber Qazt 5 digiu) Other (plpse specify in Pan 3 bclow)
_ 5ma
_ - __- _ ' _ __
Each undersiened certifies, under penalry of perjup•, that the above and foregoing infuRnation is we and cortect and that he or she is elieible to
receire the homeslead standard deduction on this propeny. Each undersiened al>o understands that, by elaiming additional homestead deductions
unlawfully, he or she may be liable for back taxesand subsiantial financial penalties.
Oan � 1 Sienswre Da�e TNcphmc
, C�- - �� , o �� ��!�"� �.
S Simamre py�� Tcicphonc
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