Homestead_Dau!
ti�
, CLAIM FOR HOMESTEAD PROPERTY TAX
- � CREDIT/STANDARD DEDUCTION
� � SUte Farm 5473 (R5/ f0-0t)
���� Presrribed by the DeDartmenl of Local Govemment Finance
INSTRUCTIONS: See reverse side for �ling instructions.
I (We) L.T C., �
I(We) occupied as our principal place of residence f
❑ I(We) owned ❑ Are buying under contracl
described real property for which a
FORM � YEAR
Cto -�
a benefidal interesl in ihe entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
If buying an conVad, Fee Simple ownefs name
ofice where wnVact is recoraed
Tamship
Legal description
(dry, town,
Is the property in question:
Record number � Page
❑ A4obiie Homo p.C. bf.1-7)
If any portion ot Ne resiEentlal SWClure w the land not excaeding one (1 � aae Iha� immediatety wrtounds thai sWCture is used lo produce income, describa Ne use and portion
of the properry utilized to produce inwme.
�'j`��`�'���'�'"i�j''�--t��i"'>+.� � �,-.�z� �'TRUEaT/UC�� ASSESSED V,4�UE Z �HOMESTEADI � � NON'-�RESIDENTIAI '� �'
p{fh�-.yA �ESSO�,�E-�O.NL.Y.�";��������yALUE;y�.yx`�.tAT�t00�OFTTV-�� ;.,VALUEtz. � �,�y.4VALUE'� °��
. '�-. _ �....Ya�S�'
Land not exceeding 1(one) aae immediatety p�,�.,t�". ;r�jF �' �'� -w� ���
suvounding residentlal improvemenls. (�� � 's "'�'F,i,`t'� -`� ` z
����:%?' � -w'?��=.
r• __
ONerland (Z) ;�:��sz' ;=4q�.s.
.. c�"�.'�'n'�....
Total land (line 1 plus line 2) �3)
Dwelling (4) ��..����� �. ���
Residential improvements �^��£�*^�' -� � ���
Gara e ` cv�"��f s� z'���5-�
9 �
(5� �`�'y3.",;�'-.��.�,�'.�S'-c'�''a:-. �°+`�;3�
'ja?:csa.' �u';�i
Other improvements ' � (6) r �� ���'"��''"�
�,,.i �?'T;�-_-'s�'e�
Tofal improvemenis (line 4 through line 6) (7)
Tdal value (line 3 phs line � (g)
I hereby certi(y ihe above is We, coneU, and Signature otwssessor oate signed
complete.
Verifyiig action - Signature of Puditor Date sgnetl
�"'�.��,���a����;'s���.�s �'��':STANDARD.UEDUCTIONALCOWANCE..-:3:',��!f��.a�*.a��""�.L��*",r�:-x°tu:���`a-.'-:=
e_
20_Pay20_
Lesser o( 7/2 Homestead
Valuation or $6,000 5
Sgnahre oflwdHw Date signeC
Gibson County Auditor'
101 N Main
PRINCETON IN 47670
�
1201
tTiIE fA0.\I!!!M12'1 sWl
.1�IR[T'Fl1 BY SI1TE BlHP�
iPFASURFA
Individuals md nu:�ied roupla are limii<d �o onc homeaead �tandaN drJunion. As thc rttript of ihis deducoon brconrcs
morc benencial, thrre is morc incrntn< than ecer for homesieazl fraud Iiomn�eacl fiawi causcs hi�her �ac bflls fw all; the¢fore.
HEA 13�1i-?IX19 requim uapaven w�ho r�acire the Mmes�eaJ sundaN deAuction ro.erify iM� �hey are eliciWe w mcervr �he
benen� aN to pnxiJe aJditio�l idemiirinc iniomiation neR.sarc ro allw� counq' gmemmrnt ro beaer mmiror IwmeseaA
filiwg.'Ifiis in(o�ma�ion will h Arry cmfdemial and ren only he araesseJ Ay awMrixd counry of&ials. The Ikpanmem o(
Loeal Gm'<mmrn� Fi�u�rce will ua this informacion [o rrea:c u�uls thm �rill hcip counn• officials diminarc homcs�<aJ fraud.
�� �� �
T•rxpa��er Nnme Prnpert�� Address
Dau, Brenl J/Stacy M
Brent J Dau
201 Freddie Ann Dr
PRINCETON IN 47670-3113
I�I��II���I�II„I���III�����II����II���il��ll�ll������lll���ll
?01 Frtddic Ann Dmc
Prince�on IN d7670
State Parcel Number Leeal Description
X 26-12-0&104-000287-028 01s-oo287-0o EnST HILL 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.
0
Address (number end sumt, ciry, sm�e, and ZIP code)
1 F.r ', C��-.. :-� � r
Smrin' Numbtt (L�si SOd�CitcJ Uriver's Licenu/Slate ID Nwnber Qasl 5
�
i�'1 c. �' �
�ilina Address (numbcr and exrce4 ciq�, stale, and ZIP code)
i�( li / ��C_GC.i 'L �-r, �'� `�-� � �
oial Stturiry• Numbcr (lu� 5 digits) Driver's LiccnsdStatc ID Nwnbcr Qact S digiis)
' ��-
� L�
Same as pmpem odd�
�-� �J �
fv iu Part 4 bclow)
`� �i_ l./
j Sumc as p�opcny addrea�
� r i_ti���y� ..J.
Oeher (please spccify in Pan 4 bclow)
�
'7 /
1
mdersigned ceniftes, under penalty of pepury•, that the above and foregoing information is wz and correct and that he or she is elieible to
e the homestead standard deduction on this pmperty. Each undersiened al>o understands that, by claiming additional homestead deductions
fully, he or she may be liable for bac:t taYes and substantial financial penalties.
1 S;ymanac r lhtc Telepnone
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