HomeMy WebLinkAboutHomestead_Collins (14)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
t State Form 5173 (R6 / 4-03)
Presafbed by Me Department of Local Govemment Finance
INSTRUCTIONS: See reverse side lor filing insfn�ctrons.
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FORM YEAR
HC10 `
��e) "��' ' `� �certify that q��s 1� dVy 6NMdreh, 20_
I(We) occupied as our p ncipal place of re /' c��h e followi g escnbed real pmperty tor which a Homestead Property Tac Credil is hereby daimed:
❑ I(VJe) owned ❑ Are buying uef6efeERiract ��7-jj ��
a ��
Have a benefidal interest in ihe entity that is liable for the property taxes on the property and that owns the property or15 p�@qtract.
r.�aSON c:
If buying on conUacl, Fee Simple owners name
RemNefs olfice where conVad is rewrded
�e�-���:��:Y.� �'�`-zs._�.`-m�:i�-.a�2,'aa✓�t�
�n�Y Tamship
dislrict (cjfA lown,
RecorC number � Page
�zi numcer ?� �/y�1 �eg i ae/s�cnpfian [� Is the propetly in queslion:
������UV� Wl• ��(„J�� �Jl$�� �� ❑Realproperty ❑MOb'leHOmo(/C67.f-7)
If any poNOn ol the restlenual sWcWre w the Wnd not axceeding one (t) aae t0a1 immediatety surtounds ihat sUUUUre is usetl W produce income, desai6e Ihe use and poNon
ot ihe property ulilized W produce income.
�.a6�,
County
I hereby certify lhe above sfatements are W e, correcl and wmplele.
(num6er arM strret, cdy, sfate,
Land not exceeding 1(one) aae immediatety
surrounding residenUal improvements.
Otherland
TUaI land (line 1 plus line 2)
Dweliing
�Residential improvements a Mnually
Assessed Mobila / ManuFacwred Home Garage
Other improvements
Tdal improvements (line 4 through line 6)
Tctal value (line 3 plra line n
I hereby certify the above is We, corred, and
complete.
Verifyirg actbn - Signature ofFwdi[or
20_Pay20_
lesser of 12 Homes;ead
vawauon w E35.000
i�)
IZ)
(3)
(4)
(5)
(6)
(�)
ig)
SgnaWre of Assessor
County
S
� ! � ��
Dale si9ned
Date sgnad
SgnatureotAUditor Datesi n
�. �_ 9�P-lD-D�
•
Gibson County Auditor
101 N Main
PRINCETON IN 47670
3964
mau.��.��r.-m
TIU4[!P. FORM
hidividuals anJ irtrricd rouple arc IimiiN to orc home.acaJ 9anJaN JMuction. As �he rtteipi ol'this dcJuctinn hecnmes
morc beneficfal, thrre is morc incentnr than ner (or M1omd'tead Gami Nartro�ead fmud causa hi�her �a� 6ills (or all: the¢fae.
NEA 13A!-NN19 cequim u�pa�en who meeive ihe hanesteaJ siandarJ JNuction ro.erily tlut �h<y me digiWe to mcene tM1e
brneft an1 ro p�w�idc alditional idrntiiyin¢ inWrmitiun nea:an� ro allw� cwnn� gmrmmrnt ro Nuer moniWr homesrcml
lilim� -'fliis inlnrmaiinn will M Aryv cmLdemial and c�n nnly M� artt. ieJ by autMrieed rounn� o(licials.'fhe IkTunmem nf
I.ucal Govcmmem PinaM'e wili uc this intomia[ion ro crwu twLa that will h;!p aemn' ulficials climinah Mrmcncad trnuJ.
. ' , , , , .
Jo Anne Collins
2020 S Main St
PRINCETON IN 476703410
�i�u��u��i��u��u���un���u�u�ni����nin�i���nn��u�
TBSpAPef �Jflle
Collins, Jo Anne
State Parcel NumAer
� 2612-18-304-001.827-028
Prnperh• Address
?020 5 Main
Princeton IN 47670
Leeal Description
019-07827-00 PT S 1&2-10 1.26 AC
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Ouncr 1 First Middlc Last
To , r�it/lJ�= �'o GL ; ,,� s
ig Addrcss (numbcr and straY. city. sutc, and ZIP codc) --� --- -- �� - -- - - - � � Somc as property odd�ss - . . . _ . _ _ .
cOcZ� S< %�7�//� S-�' / /(JC �'�U/✓ • �7�%�
$ocial Seeurily Numbcr Qan 5 dieiB) Ihivers Li<rnse/State ID Numbtr (lasi 5 digib) Other (pleate speciCy iu Part 5 below)
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Spou'u First Middlc Laa
�eCP�tSe� - --
Mailme Address (Numbcr and strtt4 cii)'. �Ia�e, xnd LIP cak) � Same:u pmpeny adJ+as
�---- �—�
Sorial Stturiry Numbcr (latt 5 digits) Drivcrs Liccasc/Statc ID Numbcr (1a;t 5 digits) Othtt (plcacc spcciH in Pan 4 bclow)
-- -
$0Y ,
• • • ,
Each undersigned certifies, under penalty of perjuq•, that the above and Foregoing informatiun is tme and correct and that he or she is elieible to
receive ihe homes�ead standard deduction on this propeny. Each undersiened al;o understands that, by claimine addi�ionai homestead deductions
unlawfully, he or she may be liable for 6ack taxes and substantial financial penalties.
Owner I Sicnanuc Datc '1'clephone �� �
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sPou�e sig�amro o-dtc raiynonc
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