Homestead_Ray (3) MATE I ORM!!y+11Cr e+2'1 TREASU4A FORM 7-IA
A?PRNED BY MUT BOBADOF AClTRLVT.l 9n PAISRBm BY MT DEPARTe4T(WlOCA WAt4RYMrWT FIANCE RH.1'4.'
Gibson County Auditor _
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction become:
r more beneficial.there is more incentive than eser for homestead fraud.Homestead fmud causes higher tat bills for all:therefore.
al
HEA 13-14-2009 requires=payers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and ran only tic accessed by authorized county officials.The Depanment of
Local Government Finance will use this information to create tells that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Ray, Donald/Carolyn R Life Est Etat
- 703 N Seminary ST
Princeton IN 47670
843
Donald Ray
703 N Seminary State Parcel Number Legal Description
PRINCETON IN 47670-1633
1111tlltttltllttlttt..• VIII ttt lltrt 111 li I11 IIttt l 26-12-07-201-000.475-028 019-004755-00 OLD PLAN 139 PT
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.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
fit fi f cb No/de RAI -
�g Address(number and street,city,state,and ZIP code) Same as property address
Dg fi/ Se-m t tv a-r S
Spouse First Middle Last
o Ai - I2osc WA.y
Mailing Address(N r and street,city,state.and ZIP code) El Same as property dress
7(97N�4i/h IN _A inf S±
-- —'-- _—'�-- ----�---Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Sig ature Date
,
•
�j^��a YEAR
� � CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION - � HC�o
+��• �• State Form 5473 (R2 / 5-92) � �
.�%
�eu
INSTRUCTIONS: See reverse side tor lilrng instructions.
/ �h � � "
` Ve) � � �.t.��y certify thai on t�1 �f day�f �f�� 79 �
0
i,e) occupied as our principal place of residence the fo owing described real pr erty tor which a Homestead Property Tax Credit is hereby Gaimed:
❑ I (We) owned ❑ Are buying under contract � � ��� � ,'��
❑ Have a beneficial inierest in ihe entity that is liable for theproperty taxes on the property and ihat owns the property or i5�,i�Ti�� coniract.
CONTRACT RECORDED -
It buying on contrati. Fee Simple owner's name -�
Recorder's oHice where comract is recorded Record number Page
Counry
Parcel u er
If any ponion of (he re5id
ot the pmperty utilizetl to
� PROPERTV DESCRIPTION
Township Taxing distric� (ciry, fown, township)
�egal description
strucmre or the land not ezceeding one (1 �
ice income.
� /3
surrounds ihat sirudure is
R
to produce income, tlescribe ihe use and portion
� � PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township CaunTy Township
�
��:by certify ihe above statements are irue, correct and complete. Si namre o� �mam
Address (numberantlsbeef. ciry, sfate, ZlPwde) �
s F.
ASSESSOR USE ONLY � TRUE TAX �ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VA�UE VALUE VALUE
Land not exceeding 1(one) acre immediately .
surrounding resideniial improvements. (�) "
Oiher land (p)
Total land Qine 7 plus line Z� (3)
Dwelling (4) �
Residential improvemenis
Garage (g) �
Other improvements (6) �
Total improvemenis (line 4 through line � (7)
Total value (line 3 pLs line � (g)
I hereby certify ihe abOVB i5 �rue, Correci, and SignaWre oi Assessor Date signed
complete.
;�ng action - Signature of Auditor Date signed
(
79 _ Pay 79
Lesser of 72 Homestead
valuation or 52.000
Sgnawre of Autlitor
�
STANDARD
S