Homestead_DorraughCLAIM FOR HOMESTEAD PROPERTI TAX
CREDITISTANDARD DEDUCTION
� Stete Form 5473 (R6 / 4-03)
� Prescribed by Me Department of Local Govemment Finance
INSTRUCTIONS: See reverse side /orllirg instructions.
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APR 4 2007
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� �e� ' 7 certiry tha�'�i1{eNsLdeyAi7Mai�.NR
I(yJe) occu i as our principal place of residence Ihe following d � ed real property for which a Homestead PropeAy Tac Credit is hereby daimed:
I(We) ned ❑ Are buying under contracf
Have a benefidal interest in lhe entlty fhat is liable (or ihe property taxes on the property and that owns ihe property or is buying under a contract.
If buying on conVad, Fee Simple ovmers name
afice whera conVad is
Counry
Parcel number
Tovnship
(ciry, town,
Is Ihe
If any portion of U,f�f�sldenUal sWCture w Ne land not axceedinp one (t) ave that immetliatety surrountls
of tha property uUll(bd W pr uce i�ome.
G�lo — /c�'��j0�� LL�• �/ �-l�o� d�
County
I hereby certify the above statements are We, coned and compiete.
street, dry, uate,
of
Record number � Page
Real property ❑ Mobile Homo (/.Q E1.1-7�
ira is usetl to produce income, tlesrfibe the use and portion
'��.'�'�`?�:. `?r`".��eJir�*,'�'.:e�A°u'.�'�`.��-..��'�STANDARD:DEDUCTION'ALLOWANCE?r>'_'"'�'l��"' '-,�-a� ''-�,"'r-�..*�_--s �`3�-�`"�' :�^-
bY'�».f3 Wi..��YTnyRS . �.9. '_ 'E..:�,..�.
20 _ Pay 20 _
Lesser of 14 Homestead
vaivaUOn ar 535.000 5
Signature olfwddw � Date signed
•
Gibson County Auditor
101 N Main
PRINCETON IN 47670
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John R Dorraugh
604 S STORMONT ST
PRINCETON IN 47670.2528
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iRFANAfA IORV :S�A
InJiriJuaL+ anJ ma�riN muplc arc IimitN io one homc�eaJ uandard Aedunion. As �he rereip[ ol �hi� dedunion bmonre�
morc brneficial, iherc i� morc incencne than ecer (or homestead fraud. Homr�ead faml causes hi�lxr uc bills (or all; thereforr.
HEA 134-i-21N19 requim m�pasen xho rcceive �he hanestcaJ smndarJ JNuction to .erify thai ehey are eligiMe b mcci.e the
benePo unl �u pmcide a�Witional iJrn�ifrmc infomianun neman to allovr eounty gu�rmmrnt ro b:urr muniror homrsread
filin��.'ITis infnrmmion x�ill 6e Aryv mnliJential and nn onk M� acee>.eJ hr authoriuJ coumy o1T¢ials. The Ikpanment of
Lucal Gmemmrnt Fivnc< ��ill uu �his iniormation W crca[e twls �ha� will help epmre offwtials diminnic humesicad fiaud.
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T:ISpa�'rf \JnIP
Dorreugh, John R
S[ate Parcel Number
X 26-12-07-404-000.718-028
Prnpem• Address
(0 0 �-1 5 �i�iio�ur.�C
Princeton IN J7670 V�I�
C�
Leeal Description
019-00718-00 KOLBS ADD 24
1 �
Ouner 1 First Middle Lut
-J�/�N �/e Da � c1G �
ie.Addmss(numberand>mztciry.smre.andZlPedde)— —� ----�—� �Sumen;propenymf�-- - - - -
Socel Securiry Number (last i dieiLS) Driver's Littn5c/51ate ID Number (lut 5 digiu) O�hcr (plcase specify in Pan 4 below�)
�
Spouvc Firs[ Middlc Lazt
Mailine .4ddress (Number and lrtt4 �h}'. sWlc, and ZfI' code) � Same u pmymy add�;
Swial Saurity Number (lazc 5 digi�s) Dmcrs Liccnsc/Sintc ID N�rtnber (la,� 5 digiu) Oeha (plcacc spccify in Pan» bclow•)
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Each undersiEmed certifies, under penalry of perjury, that the above and foregoino infurtnation is true and correct and that he or she is eligible to
recei��e the homestead standard deduction on this property. Each undersigned al;o unders�ands that, by elaiming additional homestead deductions
unlawfully, he or she may be liable for back ta�ces and substantial financial penalties.
Ownn 1 Sipisuvc DzL° l'el<phonc
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S - Sip�ature Dzte ielephonc
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