Homestead_Couts�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
1006
t1 VE fOR4!!JW lti / NMI
IAIASUREAfOM141�A
InJi.�i�uaL. and m�:riN couple are Iimi�M �o ore home�nJ aandaN d:duttion. As the rmip� of ihis dMunbn brcome.
more benencial, thrrc is morc incentnx than e�er for homrsrcad Gaud. Ilome��eaJ frdud cau�es higher ta� bflls (or ail: the¢fne.
HEA I;A-i-]IX19 requim uapa.rn who reccire ihe hanescead smndard dnfurtion �o verify tlui they am elieiNe io mrei�c the
benefi� anf ro p`m�iJe addi�ional idenuiyirc� informatiun �Ktt.-vn� �o allw� caunry gmrmment ro Nrter mmiror Iwmestead
filin��. This in(armation x'ill 6e I.ep mnlideminl anA aan only fK acce�ud M1.' wtlroriud rounp� oT¢iuls. The Ikpanmem o(
Local Gwemmrn� Piw�rce ��ill ux Ihis infomu[ion tu crcau 0.vls tha� xill h:Ip cpmiv offieials diminme Iromn�caA (raud.
• , , , , ,
T�sparer Name Pronem� Address
Couts, Michael A/Kerri A Fields
MichaelACouts �ly � ��
nn� o
OAKLAND CITY IN 47660-8153
�i�u��in�����n��n��ni�u�un����i�iu����n���u�n�n��
a I� S I lan 5'I'
Princrton IN 47670
State Parcel NumAer Leeal Description
k 26-12-07-304-001.219-028 PT -01279-00 SOUTHWARK ADD 13 PT/14
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.
�• �
�na I First A1iddle Lut
�lG'fffjLL ���9^� � Ov �.S
mg Addrecs (numher and smcct, cin, smtc, and ZlP codc) � Semc as property add�¢;
$ceial Securily Number (last 5 diGiu) Ihivas Liceme/Staic IU Nwnbrr (last 5 dieiB) Other (plesse specify in Part 4 below�)
���
Spouse First Middle Last
l� �� � .� A,�,� C o�+s
Mailin� Address (NUmbcr and sUtt4 ci�}', Slale, nnd "LIP cexk) � Same as p`openy adJress
Social Sauriry� Numbcr (lan 5 di¢i�s) DmMs LimnsdState ID Nmnbcr (la;� 5 diei[s) Other (plcise spccifi� in Part? bclow)
_ ►
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Each undersitmed certifies, under penalty of perjuq�, that the abo��e and foregoing information is we and correct and that he or she is elieible [o
receive the homestead standard deduction on this property. Each undersigned al>o unders�ands that, by claiming additional homestead deductions
unlaw�fully, he or she may be liable for back taxes and substantial financial penal�ies.
Owncr I Signenac Da�c 7'elcphonc
��� �--� o y a�/,o ( �
SpouxSi �e � (lp}C Uare Tclephone
�"� �. C�1,�'�� ����, pql2l���0 (��
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� -o N v,e c � s
�, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
SWte Fwm Sa73 (R6 /4-03)
Presriibed by the Department of Local Govemment Finance
INSTRUCTIONS: See Bverse side lor Iiling insfmctions.
FORM YEAR
HC10
• —r -� ' ') ;'�
��e) certfy lhat on the 1st day�of March,.20 !
I(VJe) occupied as our principal pl residence the following described real property for which a Homestead Property Tac Credit is�hereby "dai ���� 7
❑ I (We) owned ❑ !ve buying under coniract : ; / ��
� Have a benefidal interest in the entity that is liable for the pmperty taxes on the property and ttiat owns the property or is�buying under a wnVaG.
_ a�.n. _ _ �.�.
I( buying om m�uad, Fee Simple ownefs name
Recwdefs ofice where conVacl is remrdeE
Tamship
��
Tating dis4ict (ciry,
If any poAion o/ lhe residential sWCWre w the Wnd not axceeding one (1) aae that immetliatety
of the property ulilized tn produca inwme.
Remrd number
Page
property ❑ Mobila Homo (I.C. 6f.1-�
used to produce income. describe the use antl ponbn
+.;x'?'i_'-�`'��OSi'r`.�'s%;th� ��'�mti?s C'�� n.,.. . . _ _ � . v >}.��
-� �ASSESSOR�USEONLY`�`-�'Y�"�7-iM'�C'�T.RUE7AX �4�ASSESSEDVALUE HOMES7EAD�`'.`� NON'�RESIDEN�TIAL��pj��
x. � ,:k#:.:�aT�g,�„<x_.�'"g�.Ta��r..�..-"_..�,'y3�:n� 2z£v�..Y.M'�..ae.•cyVAI:UEi'�. .� �ATt100%O �TfVy's �.VALUE� d3�.-��"-���-ii`�4i.V/1LUE�a.�s'� ��
Land not exceeding 1(one) aae immediately � , ��a`,�yt�� �"�?°,�a.`*�u�i„N��t
surroundingresidentialimprovements. (�) �`� k ��x�``��t��"
1a �'Jivt�-d2?4 z�'%�4v�.U.c�ei�'ai��
!'�nLS}�4�� �F
Other land (Z� -� g 3 � 'a-��
?_.,',-�•-.�.-'�
TUaI land (line 1 plus line 2) �3�
�,.�� a- �^ :.
Dwellin9 (4) ��+�i'�'�'7����?
Residential improvemenLS or Mnually ���� �'�`°'j�`"`�
Asse�ed Modle / Manufadured Home Garage (5) ���`'+�."� ��i,�.���'-,�„��`"c,•�
��;, ��=�T:�: ��.�
�"'�°� ��` -�-' - -- -
Other impmvemenls (6 .� ' "�
� �����
TUaI improvements (line 4 through line 6) (��
T[la� vatue (line 3 pl�s line n (g�
I hereby certi(y the above is We. corred, and Sgnature of Assessor Date signed
complete.
Verifying actbn - Signatura oflwdilor Date signed
20_Pay20_
Lesser of 1/2 Homestead
E35.W0
Date sigy/Q � ' O� � �
�t J