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?�' CLAIM FOR HOMESTEAD PROPERTY TAX
i! -..y � STANDARD I SUPPLEMENTAL DEDUCTION
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INSTRUCTIONS: See reverse ade Im I&r�g inshvctions. ��
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plaw o resitlence w am (are) Mry'ug �he tWV.vin Cesaibed real propeM �w which a Homesteatl Properry Tax Standard DedUtyop� s here w9�ep.
uMer mn'saa on the Eate Ws app6nuon is Ned. (daroW fJing�� G'ra� N�'�'j/
❑ t(We) v+m ❑ Am (are) Eyi�g untler recordeC conVact v
❑ an �are) entitled m occupY as a tenan4stocknoWer ol a cooperalive hm�sing corporauon OIBSON COUNTY AUI
� Hava a Oeneftial in:erest in �ne wst or the nght to occupy the prooeny mMer Ue iertns of a pua4fieC personal resiaenm ws�
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1 here0y ceniy Ne aeove statements are we. correa ane mmqete. 5'�"' `�d01"" '
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Dwellln9 (d)
Gange (g)
Other improvemmu (6)
Tetal hnp�oremrnU (llns 1 Nmug� line 6)
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I hereby ceNfy tha above is Vue, correc4
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Sq�aR dAssezzor
�fl _ pay 20 _ Lesser W 60X U Ihe a:sessed vA�e al Ne MmesieaE or Sa5,000
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
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�Y TIC OEPMTff.Y�Cf L(A'.LL CAW_LYWT'i {p:A'CE Il'�I.1-Z_J I
hWiciduab and marriN coupl� are limi�ed io oce hnmc.aead �andaN h�-dunion. As �he rc[Mpt o( ihis dcduction hecomes
mere beneficial, ther< is morc irimitne dun ner for homei�ead fruud Ilomcvead fraud causes higher uc 6ills for all; ihnefare.
HtiA 13i3-?009 rcqu'va� u�papm x�ho recci�c Ihe hancstcaJ sundvd dcyfunion a rerify dut Nn� art elicidc m mcene ihe
bznefii an1 ro prm�idr atWitimul idenuiyfng infwmanun mce..�rc to allw' eounn� gm'emmem �o beuer moniror homateaJ
filim,.n�.'Iliis in(ormatinn w�ill br I,ryu mnlidemial anA can nnly h: acre:ud by awhorieed rnunn� officiais.'I1�r Ikpanmem o(
Local Gorcmmcm Piwnm �� ill um this infortnation m areatt w�ls Out arill hdn mma� nfiirialc diminno- h�nnnmaA (r.��d
1117
James R Collins Jr.
507 S Race Sl
PRINCETON IN 47670-2509
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T�apaver Name Prupem� AJdress
Collins, Andrew J
507 S Racc Sl'
Princeton 1\ 47670
State Parcel Number Leeal Description
X 26-12-07-403-000.102-028 01s-oo102-0o SUMMERS ADD 35
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.
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Oaner I First MidNe l.azt
Jar„es �I� � 6�1 I i —'
�g Addr¢s (number and stteet. city, scate, and ZI P code) �'Samc ns pmperty odd�
.�cz.c e i- � �^ i ncefo n Co C�
$ocial Security Numbc� (last 5 dieils) Driver's Liceti.e/S�am ID Nmnbcr (Is.t 5 digils) Other (plcase specify in Part 4 below)
Spouu First Middlc Lan
e � �-. �'ol li nS
Mailine Address (Numbrr anJ sUCC�, ciry�, s�aie, and "LIP caie) 1-1 Snme u pmpeny addres,
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C� S. I-�ace S.�rrnce.�a� ��i ���1 �
Social Saurin� Number (Iazt 5 digits) Drivcts Licensc/Statc ID Nwnbcr (lau 5 digils) Othcr (plcasc spccify in Pan 4 bclou�)
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Fach undersiened certi6es, under penalry of pequq�, that the abo�•e and foregoing infortnation is we and correct and that he or she is elieible to
recei�•e the homestead siandard deduction on this property. Fach undersi¢ned also undzrstands that, by claiming additional homestead deductions
unlawfully, he or shz may be liable for back taxes and substantial financial penalties.
Owncr I Si�meuac Uate Tclephone
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Spou;c Si�acutt ��� Tcicphone
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