Homestead_Fairww++ Nc �o �9�s
PrcuriDW By Sute BoarO af Taa Commissioners
To Be FileC in OuD���e
CLAIM FOA HOMESTEAD PROPERTY TAX CHEDIT FOA YEAR 19� �
SEE BACK FOR FILING INSTRUCTIONS Q�9' OO (��' �O
��� Y� �• '�" �-� ��'� ti certify that on the 1st day of
•� ..--.���, i��� I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) C� owned
O are buying under contract � •
❑ have a beneficial interest in the taxpayer
Property Description in � County �� Township
Taxing District (City, Town, Township): �/u/%t.�'+.�.t�� Q� i�^'- %
—Parcel Number or legal description shown on tax statement:
"�.o-l.ctti�a '�2CZ.e �_. r�Pa� �-/ . S� o A
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If buying on contract: Owners name �+� simo�e owner�
Contract recorded in Recorders Office - Record
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If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property: County Township
��"���c��r:i'.y-:he above statement is true, correct and complete.
i'�i j � .
�i� ���oe�-+� .� ��,.,���aK. JucK S,'f1a11 �c:�HC�?� �,,,cl, 476>c
�5�y�a}��e Sveet naoress C�ry. Stare ana 2ip Coae
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
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True Cash Assessed Homestead
� � � g> � Value Valuation Valuation
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I e..rl nnf ovrncriinn 1!nn nrr im rliafP i .
- ACTION BY AUDITOR -
Approved: /� ����c..� a,' Date: ✓r= �"'r_""' ao�
�A — i - ' — �.�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
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tl\tE fORU �}M�R'/�+YI
IndividuaL� and �m:ricJ couple are IimimJ to onc IromeaeaJ uandaN JNu.�ion. As the rc�eeip� ol �his JNuctan becmrc_
morc beneficiai. ther< i+ morc incrntive than ner for homnrcad frauJ. HonxvrsJ fiauJ causes highrr ta� bflls Wr all; eherefor<.
HEA I±+4-?fNW requim uxpa.m who r.�ccire thc hanestmJ siandard JNunion m.erify iha� �hry am eliciMC m mcei�c the
brnefi� am1 �o pnn�ide aAJitional identifi'in� infumunion Mer.sin� �o allw' counn� gm'emmrnt ro becter munieor Iwmrnead
lilin�.�.'ILix in(ormmion will he Aery ecuiti�.'emial anA rvn nnly R acm: cnl Ar amMrvtA county o0iciuk. Th< Ik7unnient of
Lsil GmormMm Finane< ofll u.e this iniurmation ro cream trols that n'ill hcin camre officials elimieum humesieaJ fnuJ.
APR � zu�u
3728 '�]�7 ��
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Donnie R/ Car ` COUNTY AU�����
Qil��
1006 S Hall ST '
PrincetonlN 47670.2824
���n���n����n�in���nni�i��u�in�i�i�u���nu��ui�u��
Taspa��er Name Prupenc Address
Fair, Donnie R/ Carol D
1006 S Hall S'1'
Princeton IN 47670
State Parcel NumAer Lesal Description
26-12-18-103-000.798-028 019-0079&00 ROBERTS Pv,CE 4
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�uner I Fim MidNe Las�
�ohn te Rq �Q%�'
.ig Addrts (numbcr m�d evcct, ciN, smtc. snd ZIP codr) � - - -- —`�-' �' Snme as pmpertv ead�¢c - -- - � -- " — —
100 (o S, I-I q I/ St Pr�'nce toy 1'_ti �/7/�70
$ocial $aurity
S�wuse First Middle Latit
Caro� C�r'ar�� �Uir
Mailing Addttss (�umbcr anJ alrce� �i�}', sutc. and ZIP wtk) �Sune u pmpertr addrts;
%006 S, ��fqll S7` I°r;nc��oy� Z.t/ l,����c�
Social Stturity Number (laa 5 digi[s) Driver's LiceasdStare ID Nmnber Qac� 5 dieiti) Oiher �pleise speciN in Pan 4 bclowy
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Each undersigned certifies, under penalty of perjury•, that the abo��e and fore�oing infurmation is we and correct and that he or she is eligible to .
receive the homestead standard deduction on this propeny. Each undersiened also understands �hat, by claimine additional homestead deductions
unlawfully, he or she may be liable for back taxes and substannal financial penalties.
Owna I Sijgna�'`` Dnte Telephone
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