Homestead_Dougan�{ R�n
CLAIM FOR HOMESTEAD PROPERTY TAX
i;° � CREDIT/STANDARD DEDUCTION
Y�` + State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side lor filing instructions.
FORM
HC70
YEAR
� . . :. . ' , .. •. � � , .. - � . -�:-�CERTIFlCATION SiATEMEHT^. K",.. . .
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I(We) _ certiry that ori tBe 1 st day of �March, 79
I�l� !' � ��' A `
I(We) occupie as our principal ptace of residence the tollowing described real pro y for which a Homestead Property�Taz Gr�t is hereby daimed:
'� I(We) owned ❑ Are buying under coniract ��� ���"' "
� Have a beneficial interest in ihe entiry that is liable for the property taxes on the property and that owns ihe property: `� b� iig urMer�a coNract.
LU�U
If buying�on contrad. Fee Simple owner's name
Recorder's oHice where contraa is recorded
. _ „ . , . . CONTAACT RECORDED
� h!-�-�':.i-.f-. � -
' " G!�SO^ ;
Record number
� L::.. - ,�._'
Co� n Township Ta�nng tlisind (tiry. (o r)
dsel n�ber �� � � Legal descnption � / � �
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If any ponion of Ihe res"Wential stmcWre or !he land not exceeding one (1) acre that immediatety surmuntls that structure is used ro produce inwme. describe Ne use and ponion
of the properry utilized ro praduce income.
' PROPERTY OWNED BY
Counry TownSNp
I hereby certify ihe above statements are tme, correct and complete.
�number aM street. dry, state. ZIP code)
%/ y ///, /J/fl /T�
�� ASSESSOR USE ONLY `� TRUE TAX� ASSESSED HOMESTEAD� NON-RESIDENTIAI';"
� .. � VALUE VALUE VALUE VALUE -
Land not exceeding 7(one) acre immediately - � �-
surrounding residentiai improvemen[s. (�)
Otherland (p) _ � �
'.id�".
Total land (line 1 plus line 2� (3)
Dwellin9 (a) � - .
,.
Residential improvements .
Gara9e (5) " ` '
Oiher improvements (6) �
Total improvemenis (line 4 through line � (7)
Total value (line 3 pbs line � (g)
I hereby Certify (he above is iNe, Correct, and Sgnamre of Assessor Dare signed
complete.
Verifying attion � Sgnature of Auditor Date sgned
79_Pay19_
Lesser of V2 Homestead
y,�luation or 52,000
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Gibson County Auditor
101 N. Main SVeel
Princeton, IN 47670
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+RFASI.1lEA �1IlM lSl�
YlFiNAV�IC61.�-33d1
Individuals and married couplec are limittd m one homettead nandard deductiou. lc the `eceip[ of Ihis deduciian bewmcs
mare 6encfrcial, �here is more icrcemi�x tlw� e�sr for homatead Cmud Homes�esd fmud causcs ttigter ux 6ills (or all; �hercforc,
HEA 134M1-?009 rtquim tazpaysrs wtro cecei}z t6e homestead s`andard deducuon �o �rrify that they are eli�ible a recenc the
bencfit and to prrnidc edditlonal idrntifying infortneoon nttc5.'a�y b flllOw' cOUntv �0��¢mmtct b bCtter monitor hocnestead
filings. This infortnation will be kept confidrn�ial and can ovh� be accessed by aue6orized wunrv officials. 7'he Depanmeut of
Taxpaver Name
Dougan, Lane Jr / Andrea K ,
Lowtion Address
714 N MAIN ST
PRINCETON IN 47670
686 =
�` �ane Jr / Mdrea K Dougan Jc II�I�III��III uII�I �II�IIW II �III �I�II�I�I �II�II�II�I�II�II I�I IIW II �Il�llul�ll I� II
214 N Main
' Princeton IN 47670-1506
�'�1�'lll��"���I"'I���'�i�"��'I������"�'�'�"����'lll'��'���� State Parcel Number Lenal Description
2E72-07-102-002.557-02�OLD Pvw 144 PT
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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.
er 1 Fvst
Lqne /1/vlan
ine Address (aumber and sveet, city, staic, and ZIP code)
� �y N. M a�n streef, Pr�'nee-�on, �
�, s�;ty,�� c�t � a���> : m;,,�rs ���ws,�� m,�� c,� s a����
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Andr2Gl
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KriSiin/
,/�„s fi._...Pri�c�-foh, ��1 c���
;iu) � Driver's License/Statc [D Numbcr pan 5 digics)
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Other (please specify in Part 4 below)
5we � -� � � . ..
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,�:� �, P����y �a.�� -
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Other (plcase specify in Part 4 belowJ
idersigned�certifies, under penalry of perj�ry, that the above and foregoing infortnation is vue and correct and that fie or she is eligible to
the homestead siandard deduction on this property. Each undersigned also understands that, by claiming additional homes[ead deducrions
�lly, he o ay be liable for bac es and substantial financial penalties.. � � _
Sig� � - Date Telephone � � � � ^ � ��
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