Homestead_Dick (4)�"` """ - CLAIM FOR HOMESTEAD PROPERTY TAX
�j; CREDIT/STANDARD DEDUCTION
O� ;� State Fonn Sa73 (R2 / Se2)
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INSTRUCTIONS: See reverse side lor liling inst/uctions. . PR z
3 1001
�� CERTIFICATION STATEMENT .
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I (VJe) � � certity thaT bQ�i�('�t,/d�
I(VJe) occupied as our principal place of esidence the following described real properry for which a Homestead Property Tau Credit is he�eQ�QBm, d:
�(We) owned ❑ Are buying under contrect .
Have a beneficial interest in the entity that is liable for the property taxes on the property'and that owns ihe property or is buying under a contract.
CONTRACTRECORDED
If buyin9 on conuact, Fee Simple owners name
Recordefs ottice where contract is recorded Recard number Page
PROPERTY DESCRIPTION
Counry Tovms�ip T�ng district (ciry, [own, fownship)
Parcel number - `egal descnp[ion
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If any portion oi�«�� en- oai snaceure or me iana noi exceeding one (1) acre ihat immediatety sunounds Nai structure is used ro protluce income, tlescribe Ne use antl ponion ot
Ne properry utllized to produce income. �
PROPERTY OWNED BY CIAIMANT IN OTHER COUNTRIES
Counry Township - . Couniy Township
S aWre of Gaimant �
hereby certify the above statemer.ts are irue, correct and complete. w
Adtlress (number and street, city. stare, Z/P code)
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ASSESSOR USE ONLY TRUE TAX A SESSED HOMESTEAD NON-RESIDENTIAL
_ VALUE VALUE VALUE VALUE
tand noi exceeding t(one) acre immediately (�� _
surrounding residential improvements.
� Oiherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signature m assesor �ate signed
complete.
Verifying action - Sig�ture of Auditor Date signetl
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead n�
Valuation or 52,000
Signature ol Audiror Date signed
3--0
Gibson Caunty Auditor
101 N Main
PRINCETON IN 47670
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APR 1 2 2010
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GIBSON COUNTY AUDITOR
1069
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1FFASURFA fU0.4 �3��
C-0�4RYMCR'I iM�SCE IC 6LI-L'-!.I
IndividuaLc anJ ma:riN mupks are limiied to onc homc.tcaJ ua�MaN d:duc�ion. As �he rmtip� ol tlti> dcductian becomc
more beneficial, there is morc inantire than ecer for homesteazl fmmi Homea,raJ inuJ causcs higher �a� bills tor all; therefue.
HEA 13i3-]OW requ'ves uapayen v�ho receive �he hanes�eaJ smndird �iffuc�ion w veriiy tfut they ve elieiGe lo recene �he
benefii anl ro p�m'idr adlitioiul idrnni�'ine information mmsvrc ro allw� counp� ea'zmr.em �o b:tter monimr homcstcal
fili��. This infomution will be le�u mnfidemial and can nnly Fa arresud br autMrirnl rounn o(Ticial+. T6e Ihpanmem of
Local Gw<rnnem FimM'< �vill u+c �his iniortnation tu arcate 0.ds that �rill hcip cauna� uffieiaLa elimimle Iqmestead naud.
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Tasperer Name Propert�• Address
Dick, Robert W
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Robert W Dick
PO Box 1095
PrincetonlN 47670-0795
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State Parcel Number Lesal Descriotion
X 26-� Z-a�-401-002.593-028 019-02593-00 OLD PLAN 10 PT
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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Ownn I First MidNe Last
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ie Addr�s (numbcr und �trcet, ciry, state, and ZIP codc) / � Somc ss propem addl¢;
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$ocial
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Spou;e First Middlc Lazt
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Mailine Address (Number anJ stree4 �q', state, and ZIP coJe) �Svne az propem ad�w
Social Stturity Number (lazt 5 dicits) Dri�•
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Each undersi�med certifies, under penalty of perjuq•, that the abo��e and foregoing infonnatiun is we and wrrect and that he or she is eligible to
receiee the homes�ead standard deduc�ion on �his property. Each undersi¢ned al;o understands �hai, by claiming additional homestead deductions
unlawfully, he or she may be liable (or back taxes and substanhal financial penalties.
Owner 1 SiymaUUC Uate 7'cicphonc
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