Homestead_Culbreth�E R�{�
e/-' °, CLAIM FOR HOMESTEAD PROPERTY TAX
3'�';: CREDIT/STl;NDARD DEDUCTION �
�,r State Porm 5473 (Fi2 / 5-92)
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INSTRUCTIONS: See reverse side !or filing instructions.
PORM
HC70
4
YEAR
��) L�� �u r�.��_.l-i� �Q.�..a_n i� - certify�thai orf�in�i t� �(iQ�'ch, 19_
) occupied as our princiPal p�ace of residence the following descnbed real property for which a Homesiead Ploperty Tax Credit is hereby Gaimed:
� I(We) owned -❑. Are buying under contract- �. _ . �
,� t,
❑ Have a beneficial interest in ihe entiry ihat is liable for the propeny taxes on ihe property and thai owns ihe p`opeciy; orv, act.
•- � ' �W�ITOR
- • - � - CONTRACTRECORDED� � - � � �
tl buyirg on contracl, Fee Simple owner's riame " - . , _ •
Recorder's ottice where contract is recordetl Recortl numDer Page
ASSESSOR USE ONLY ' TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL �
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvemenis. (�) �
Oiherland (2)
Total land (line 7 plus line 2� � (3)
Dwelling (4) �� �� �
Residential improvemenis
Garege (g)
Oiher improvements . (6)
Total improvemenis (line 4 through line � (7)
Total value (line 3 p�s line � (g) �
I hereby certify the above is irue, correci, and Sgnamre of Auessor Date signed
complete.
V�Pntying action - Signature of Autliror Date signed
19 Pay79_
Lesser of 7/2 Homestead
Valuation or 52,000
of
STANDARD
S
Gibson County Auditor
101 N Main
PRINCETON IN 47670
�
867
iRE�SURfAf00.4�-�n
RFO:A\CEICVI.1"-I�.1
InJiviJuals aod rturticd roupkti are limimd m orc homeveaJ aandaN deduniim. As the rtteip� ol Nis Jcdce�bn becomes
mere beneficial, thrre is mwe incenmx th�n <cer for hortresiead fraud Ilomr�eaJ fcwd causes hi�her �a� bills ior all; thereforr.
HEA 13�1-1-3(N19 requim uxpa.m who receirc ihe hanes�ead standard JNuction m vrri(y �hat tAe}' are eliciNe �o mce�e tAe
benefit amt ro p�m'ide addi�ional identiiyim_ In(wmation necrsvry ro allw� ewnp• ememmenl ro bener moniror homese�rJ
filing.. Ihis in(ormaiion will be I.ep mnG�avial and can only 6e acrosN 6y awMroid oounry� oRcials.'fhe Ikrywnmem of
Laal Gwemmrn� Fiv�rce will u.e this informa[ion [o cream tmis that a911 hcln iamn� ufkial. diminne hrnnea.aA Gaud
Andrea L Culbreth
207 E Pine
PrincetonlN 47670-1621
I�I��II���I�II��I���III��„��II�II����I�I���IIII���I���II�I��I
Tazpever Name Prnperh� Address
Culbrelh, Andrea L
?07 E Pine
1'rinccton IN 47670
State Parcel Number Leeal Description
X 26-12-07-201-003.403-028 01s-03a0300 OLD PLrw 135 PT
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.
�/r��� 1� - � L ��/s1/'
Addrtss (numbcr end svcct, ciry, staie, and ZI P codc) �� �
'.l .n /.1 � i /ii r _ /�/�
ccurity Yumbcr (lan 5 diei�s) Unvds Llcense/SUte ID Nmnbcr Qasl 5
First
C � .� �4 N� � ¢
Address (Number and stree4 city, sia�e, anJ LlP coJr)
i
7 �; �- P r c�.
tturity Numbtt Ilas� 5 di¢iti) Drivers Limnsel5tate [D Nwnber (last 5
� � � �' « '
�C' ul
ac pmpem oddms;
Other (pleaze specify in Part 4 below)
�
:�s propeny addres
Part 3 below�)
Each undersiened cenifies, under penelty of perjup�, that the above and foreboing infortnation is we and correci and that he or she is eligible to
receive the homestead s�andard deduction on this property. Each undersi¢ned also understands that, by claiming additional homestead deductions
unlawfully, he or she may be liable for back taces and substanrial financial penal[ies.
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