Homestead_Everett° CLAIAR FOR HOAAESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stete Fortn 5173 iR6 / 4O3)
P'maibed by the DepaMrorrt d Loral Govmnmerrt Finar�e
�NSrnucnoNS: s� ��.e. a� b, rr,p �mumn,s.
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FORM YEAR
HC70
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I(We) certify lhat on the 1 st day of March, 20_
I(We) occupied as our principal place of residence the following described real property for which a Homestead Properiy Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under contract v/(�� `� �
' Have a benefidal interest in the entity that is liable for the property taxes on the property and tliat ovms heBproperty�o�s�a�yi�ix�' b�rpe wntract.
If buyinq on conVaq, Fee Simple owner's name
Recmdels o14ce where conVaa is reoorded
Tamship
Uly �?553 �C� � �� �GjC� �i
If any portion of Ihe residanilal sWCWre w tlie land not axceeding one (1 � ace Ihat
of Uie propP.rty uti"¢sW to produte iuome.
County
I hereby certify lhe above statemenls are W e, conecl and complete.
(numberarM straef, rity, sfafe, ZlPcade)
� n / S. L✓n C /..' .. „ �
Land not exceeding 1(one) aae immediatey
sunounding residential improvements.
Other land
Total land (line 1 plus line 2)
�RasideMial improvements orMnuaDy
Assesaed MohBe / Manufactned Home
Other improvements
Dwelling
Garage
Tdal improvements (line 4lhrough line 6)
Ydal value (line 3 pl�s line �
I hereby cer6fy ihe above is W e, corred, and
action - Signature oflwditor
20_Pay20_
Lesser of 1l2 Homestead
VewaUOn or f35.000
(�)
(Z)
(3)
(4)
(5)
(6)
(�)
i8)
Sgnature ofAssessor
Remrd number
Tating district (ciry,
Page
17 � �� q���,:
rt� woaem O nwwia No�„o u.c. b,.,-n
that cwre is used b produce income, desmbe the uu and portion
County
�nature ol aim 1
'�on �/J/ G/767
$
signed
signed
Dale s ed
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
•
3856
aiueenxm.�w�ki..ri
nmarn'ennr �r�te arnxu
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6�dividuals and irt�:riN couples are limi�ed io onc hoineaesJ �andaN U�duaion. As �he rttrip� nl ihis deJunan b�.�comcs
mere bcnefidal, ther< u morc incentnx rhan e�er (er homesmad frauJ. floma7ea7 fr�uJ n� hi�her ta� bilis iar all: themfae.
HtiA 17�ti-?IX19 rryuime ua�u�m x�ho reccirc Ihc hancs�rad slanduJ Jnlunian io rmfy Ihnt they am cli�iMc lo mcci�c Ihe
benefii am1 to prt�'iJe aJJiiiunai iJrmifi'ing infurmatiun nemvrc to alluw' countp gmemmrnt to betrcr muniror homesttaJ
filin��.'Ihis informaiion x�ill br Aery mntidefuiai and nn nnly h� acce: cnl hy autMriicd rnunir offirinl.. The Ury+annrcnt of
Local Gov<niment Fi�uM'< will u.c this intormation W crea:e 4olz that will h:lp eqmn� offitiaL.' eliminam homa�eaJ fraud.
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Ta�oacer \ame Pronem� AJdre�s
Everett, Chad F/Shelly A
eowo
PRINCF fON I� �7670
Chad F Everett
1101 S Washington State Parcel NumAer Leeal Description
PRINCETON IN 47670-2704
--I I II I II 1 III I II III I III II I I I_. _ 2��2_i8-?oz-ooz.ass-ozs 019-02853-00 SS ADD _ _
i n n� � n ni �mi � �n un n unn u i . _ � 326PTI327PTI328PT __'_-__ '. —_
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STATE FOItM 5)SOV (Y?/ &101 TFFASI:RFA fOCMTSI.�
APpRU'EDBYSI,�TEPQnRUOfN'COUYfSMP PRETCIi�OmBYT�OfPARTM�IOFIDCa1.CA�1A\MEY�FINAV(£IC61.1�33�L1
Gibson County Auditor � � � � � � � � � � � � � �
101 N. Main SVeel �ndividuals and married muples are limited m one homestead standard deduttion. As [he receip[ o( �his datuc[ion hemmcs
P��CRtO�, �N 4�670 � � mom 6eneficial, �here is more inttntive Itw� ccer for homaiead (nud. Nomestrad faud rauus hightt mx bills for all; there(ore,
HF,A 134A-?009 requirts ta[prsr5 who recei�x the hamcstead standard deductian m verifq tha[ thcy are eligiblc [o cecenc Ihe
o� I I� E D �cfit and to prmidt addioonal idrnufiing infortna�on necessary b xlloM county gwmunrnl �o bcttu monitor twmeslwd
- filin�.s. 71us information will bc lcpt confidrntial and cAn onty be attessed by amhoriud coumy officials.,Thc Departmrnc of
I.ocal Ga'ernmrnt Finance wi0 use ihis infortnation to create [ool> that will hely counry officials elimifute homestead fraud.
_ AUG 2,3 2011
_ c.�.m�
— GIBSON COUNTY AUDITOR
3883
Chad F Everett
1101 S Washington
PRINCETON IN 47670-2704
�di�ll�l��llli�hliiiii���,iii�qnihib.,�i.,�iiuyy��qiii,
Taxpaver Name
Everett, Chad F1Shelly A
II�I�III��III ull�l �III ull I�
Location Address
1107 S WASHINGTON
� PRINCETON IN 47670 '
�II �I I I I I�II ��II� II�I �II I� II
State Parcel Number Leaal Description
2&12-18-202-002.853-028 SS ADD 326 PT/327 PT/328 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.
Addrzss (nwnbcr and s�ct, city, statc. and ZIP code)
.-. . ._ 1 , (� C"i � i
ecurity Number (la5t 5 digits) `�' Driva's LicensdSta[c ID
�
iriry Number Qatt 5 digitt)`-� Drivers Liccnsc/Statc ID Numbcr (lazt 5
s�x
undersigned ceriifies, under penalty of pepury, that the above and foregoing information is tme and cortect and that he or she is eligible m
:e the homestead standard deduction on this property. Each undersigned also understands that, by claiming addirional homestead deductions
vfully, he or she may be liable for back�ta�ces and substantial fmancial penalties. ,
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