Homestead_DonnellyC
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"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� .._-, STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 6-09)
�O p Pmsuibed by ihe Department of Loml Govemmerrt Firiance
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INSTRUCTIONS: See reverse side for filing inshucfions. � , C.�-
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� M/e) certify that I(we) occupied as my (our) prindpal
place of residence or am (are) 6uying Ihe following described real property or which a Homestead Property Tax Standard Deduction is hereby daimed
under contract on the date �his application is filed, (date o(filing): �
❑ I(VJe) own ❑ Am (are) buying under recorded wnVact �
❑ Am (are) entitled to owupy as a tenant-stockholder oi a cooperetive housing corporation
� Have a beneFicial interest in ihe wst or the right to occupy the pmperty under the terms of a qualified personal residence hust
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Name of da nl (1 n )
SodalSetvriry nimtei of damiant (lacf
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Soaal Secuny number of daimanCs spouse (lasl five tl'g'RS) Orivers license / Identificalion / Other number Issuing State -
o( tla'una�rt's spouse (/ast (rve dqifs)
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If buying rn contract, Fee Simple owneYS name ` '
Recorders offxe whe2 contract is recorded • Remrd number Page
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�n Tawnship Tating G(rity, Mwn, t ip)
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� Parcel number Legal desaiption Is �he pertyin queslion: .
' Real property ❑ MnuaOy a:sessetl mobile hdne (IC &1.1-n
If any ponirn of Ne residential sWCW�e or the W�W not exceedi� ane (1) aQa [hat immeEiately surto ntls �hat struclure is used to podure irxome, descri�e the use and portion
of Me properry u0T¢ad to p�oduce income.
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Caunry Township Counry Towrahip
I hereby certify ihe above statements are We, correct and complete. Signa daiman �
AOOress(nUmbeiaMSheet,tiry,5tafe,aMZlPCOde) � � , •
� 330 �iA v • /r'' c./.,/
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land not exceeding �(one) acre immediatey ' '- �� �,�i3' r��'-
sunoundin residentialimrovemen�. ��) �:���-,,�„}�'�°..'���"'�
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Other land (2) pc�^�,� �}�_. .
Total land (line 1 plus line � (3)
Dwelling (4) -X'u�re-'E � � '�.''_n_T'�`�4 �x!��—a�,�-
Resldentlal improvements orMnually �� � ��'�` `e� �k^3`-
0.ssessed Mobik / Manufactured Home p; = �' �°� � � �1''�§„`N .,. � 'E5
Garage (5) „ w.w�'�`�: `��``�.,` ��:�`ar':.��--'r
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Other improvemertts (6) z� �� �j �.�� ' ' �
Total improvemen6 (llne 1 throug� line 6) (7)
Total value (llne 3 pl,c line 7) (8)
I here6y certify the above is We, cortec[, Signature atAssesmr . Date signetl (month, day, yearJ
and complete.
Vaifyirg aceon - SignaNre of,Widitw Date signed (rtronth, tlay, yearj
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20 pay 20 Lesser of 60% of the assessed value of ihe homestead or $45.000
NoM1Vithstandug any ofherpmvision, the sum olthe deduct:ons provided in lC G7.7-71 fo a mob�le home Ihat is $
rot es,vessed as real property a lo a manu/actured hortre Nat ¢ rot assessed as rcal properry maY rrot emeed .
ane-haH (12) ol Ne assessetl re/ue a/Ne mo0de home or manu/actured home.
Signatura ofiWditw Date signeC (monfh, day, yea�
Gibson County Auditor
107 N. Main Sireet
Princeton, IN 47670
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— APR 9 2012
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GIBSON COUNTY AUDITOR
1805
IR:ASUP3AIU0.ViSL4 ,
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InJi�idual. and mvriaf muplc� atc limitnl to o:u hon�!rad iianQvd Jaluctiun. A. ih.c receipi of tM1i> dNuctiun hecume�
mom hn.fieul, dw-rt is more ir.antim ihan cczr �or hom:�¢ad G�ud. tlumeetcad @aud eauvs ni�her 4�� bi0s I'or.lh eh Tr(art,
IIF \ 13{.-�pp9 reyuirs uxpwrn u'ia �ar.ice :he homcwaJ .�andard deJuction m eerif)' that ilrey arc eligiMe to rtcti�< Iht
hncli� a�uf m p�midc aidfuonal idrnufi'fm� inimnuiiim m:csian� io al4�x counn� em'cmmcm ;o Lt-�¢r mniwr homcacad
filinu. Thi. infarmatim Nill be Aep conf�ential md can onn� be :mcc�.eJ b�' auJwriud rounq� oflicu6. lhe Depanmam of
Lacal Gocerrr,nrni Pinann will use ihi. fnformaiion m cr7�e iooh �hat x'ill hcln counn• ufUCfab elimim�e home.ueaA InuJ.
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� TaxpaverName LocationAddress
Donnelly, Harry Christopher
Harry Christopher ponnelly
1330 Danvin Ave
PRINCETON IN 47670-2816
�II�II���u�li��iP�ll�ilrnl�i��rll�hhl���l��rnl�h�hr��
7330 DARWINAVE
PRINCETON IN 47670
�III III�I�II�II �II�II�II�I�II�II �I II�II��II II�I�II I� II
State Parcel Number
26-11-13-204-002.170-028
Leqal Description
MCKAW SUM 61 PTI62 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.
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Olha (plcasc spcci(y ir. Part 4 bclow)
undersigned cenifies, under penalty of perjury, that the above and foregoine information is we and cortect nnd Ihat he or she is eligible to
�e lhe homestead standarcl deduction on this property. Each undersigned also undcrstands lhat, by claimine additional homestead deductions
+fully, he or she m�} �be liable for back �es and substantial financial penalties.
�^ � ITelepho�e � � / ^ �
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