Homestead_Story •
alit FORM lK la:/fall rerssuUR FORM:SIAi
A MOVED BY',TATE BLOOM VrTII siM rFn,lBT BY THE BEPMTQYf OF REAL GoveRYMR.T FP:a'CE lc H.I-:-,I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead s andanl deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than e'er for homestead fraud.Homestead fraud causes higher ON bills for all;therefore.
HEA 1344--2009 requires taapavers who receive the hotnestead standard deduction to verify that they am eligible to receise the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.ibis information will be kept confidential and eon only be accessed by authnrired cnumv officials.The Department of
Local Government Finance will use this information to crease tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Story, Richard E/ Michael A
504 W State St
PRINCETON IN 47670
2537
Richard E/Michael A Story
P O Box 1184 State Parcel Number Legal Description
PRINCETON IN 47670-0884
lllllIllllll lIl llttt lIIII tl III,lt tat lIIIIlllull lIil lltIlltt ll A 26-12-07-103-003.110-028 01 9-03110-00 DEVINS ENLG 3 PT
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
RrcN>geD E • 5ToRy
g Address(number and street,city,state,and ZIP code) - — —-- - - -❑ Same ns property address
f 0- 80Y, 118`1 pCNC TON 1N q'76'70 - 05i8
Spouse First Middle Last
AAIcNAEL A • Sio1y
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
P. O . 'Box 1131/ Pt.INCE;ON , ?N %!76'70 - 088y
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 Signe • Date
•
�lE���f - • .
e� °, CLAIM FOR HOMESTEAD PROPERTY TAX
i��I� CREDIT/STANDARD DEDUCTION
.�:;;� SWte Fortn 5473 (R2 / 5-92)
ien
INSTRUCTIONS: See reverse side !or filing instructions.
� � � ; p�
,: �� � • s,�
�
� ���
W/t/rLR/ � v .
i"Ne) �rn � certify tha dey of rch, 19_
M 17.
��J occupied as our principal place of residence the following described real prop for which a Homesiead Property Tax retlit is hereby Gaimed:
❑ I(We) owned ❑ Are buying under contract , .
❑ Have a beneticial interesi in the entity that is liable tor the property taxes on the property and ihat owns the property or is buying under a contraci.
CONTRACT RECORDED— �
It buying�on cnntracC Fee Simple owner's name `� – , . � - '
Recorder's ottice where contraa is recorded qecortl number Paqe
Counry
Township .
PROPERTY DESCHIP'fION
iln� e_ O�� I O� I Legal description ,�`3��
ponion of the residen;ial sirucwre or the land not erceedirg one (7 � acre ihat immediately surrounds
property utilized to produce inwme.
town,
used ta
income, descnbe the use and portion
0
. eby certify the above statements are true, correct and complete.
Atltlress (numberandstreei. ciry. state, ZlPCOde)
ASSESSOR USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential impmvements.
Otherland
Total land (line i plus line Z�
Dwelling
Residential improvemenis
Garage
Other improvements
Total improvements Qine 4 th�ough line �
Total value (line 3 pLs line 7)
I hereby cenify the above is true, correct, and
complete.
V,r{(yi�q action - Sgnature o( Autlitor
�9_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000
TRUE TAX
VALUE
(�)
(2)
(3)
l4)
(5)
(6)
(�)
(8)
Signawre oi Assessor
of Claimani
.Sv`f G/, i�4 f2
ASSESSED � HOMESTEAD
VALUE VALUE
STANDARD DEDUCTION ALLOWANCE
S
NON•RESIDENTIAL
VALUE
signed
signed
amre oi Autlitor � Dare signetl
;�- ��n�.�.. � �l �-?./� - S-/�
_ � -