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aa%-� ; CLAIM FOR HOMESTEAD PROPERTY TAX
����� CREDIT/STANDARD DEDUCTION
�; � State Porm 5473 (ft2 / 5-92)
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INSTRUCTIONS: See reverse side Ior liling instructions.
FORM
HC10
YEAR
� �We) ��r(J � l� l I �.J V T � . � � certify that on"the 7 st day of March, 19_
) occupied as our principal place of residence the following described real property for which a Homesiead perty Tax C di i hereby lai
U I(We) owned ❑ Are buying under coniract . . �
- --�u �'�Ltt.*v yl1DiTOR
❑ Have a beneficial interest in the entiry ihat is liable for ihe property taxes on the property and ihat owns ihe properry or is 5uying unGer.a contract.
-� . �� � - � . CONTRACTRECORDED � ` � - ' .
If buying on wmrad, Fee Simple owner's name � ' - � .
Recorder's oNice where contraa is recorded Record number Page
PROPERTY
fown,
Parcel number Le� Ipescnpfion
0I9 —b�'83 -00 /V,O("�tb/'ooL'' �I ��5 - c
It any portion ot the residential svuaure or ihe Wnd not exceeding one (7) aae that immediatety surmunds
of the pmperty utilized to produce income.
is used to produce income, describe ihe use arM portion
. ASSESSOR USE ONLY � TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL,
VALUE VALUE VALUE VALUE �
Land noi exceeding t(one) acre immediately '
surrounding residential improvements. (�) ��
Other land (p)
Total land (line 7 plus line 2� (3)
Dwelling (4) � � �
Residentiai impmvemems �
Garage (g) I �
Other improvemenis (6)
Total improvements (line 4 thiough line � (7)
Total value (line 3 pt�s line � (g)
I hereby ceRify lhe above is irue. correci, and Signature ot Assessor Dare signed
complete.
�i�g action - Signa;ure of Auditor Date signed
L �
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Gibson Caunty Auditor
101 N Main
PRINCETON IN 47670
234%
IIAE T0.N Jy+�R'I up
nnien'[n m' �nre xNaonr mwi�n. m.
mr.vcuau wa� s�n
hWiciJuals aiid irt�rrittl coupks are Iimiied io onc homtaeaJ siamlaN Jcrluc�ion..A� Ue receipi ol ihis dedunion Mcomee
mure beneficial, there i� more mcentnx dun rcer ior humestead fraud Ilome��ead ;raml eaa� higM ta� bills (or aIC [hertfor<.
HEA 13a-i-?IX!9 requim uipa�m who rccri.e ihe hnnesiead siandarJ �vluaion m.erify �lui tM1ey ye eliciNc io rccei.e the
benefit an1 ro pnw'id� aik}i�iuful identiirinc intormnwn nemiln� to allw' counn' gwrmment �o bever mmitw IwmesttaU
filin��.'ITis in(nmulinn aill be Ary4 mNideMial and nn nnly h acrttacd by authari�M rnunly nfTci�als. �I'he Ikryunnrent of
I_ocul Gm'emmrn� Pinance will ua this iniurmatiun W<r<ate t�vls �Iwi will h:ln �nn' otbciai> climimm Iromermad haud.
Dan J/ Lou Ann Gilbert
1704 Brentwood
Princeton IN 476703320
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Addrcv (numhv m�.l��l�'4.iiy.-�mtc, and ZIP coE.j
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iline Add�ati (Number and etrttt cilp, siele, and ZIY cak)
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Tazoacrr \amr
Gilbert, Dan J/ Lou Ann
Prooem• Address
� 7oi �3reniw�ood
Princeton I\;7670
Stare Parcel Number Lesal Description
26-12-06-401-000.083-028 079-00083�00 NORTHBROOK HILLS 20121
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undersi�,med certifies, under penalry of perjury, that the above and foregoing infurtnation is tme and cortect and that he or she is elieible to
�e the homestead standard deduction on this property. Each undersiened also understands that, by claimine additional homestead deductions
�fully, he or she may be liable for back taxes and substantial financial penalties.
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