Homestead_Gray�'`� CLAIM FOR HOMESTEAD PROPERTY TAX
� ,�j CREDIT/STANDARD DEDUCTION
State Fam 5a73 (R2l5-921
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_ INSTRUCT70NS: See reverse srde 7oi l'Jing instrvclions.
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FORM Y�
HC10
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� M'e) certity Itiat/o'�n the 1sI Eay of Marth, ti9_
I(We) oaupied as our principal ace of residence the f I described real pro for whichtp�omestead P p�7ax Cr it i ereby davned:
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❑ I(We) owned ❑ Are buying under cont2ct �. �. �=%��-� 1�
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❑ Have a beneficial interest In the entity ihat is liable for Ne property tazes on ihe property and that�owns ttie'properry a is�biryirig under a contract.
i� ouyug on canmac� ree �mque owners name
Recarders otfice where wnvacc is recorded
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CONTAACTRECORDED
PROPERTY DESCRIPTION
�V (AJ �' � ( �ega aes/.C/ (L!N � / r h 1
residentral suucture a tne una not esceeding one (t� aae ediatey surtounds thai swcture is
�o uadvice Noane.
PROPERTY OWNED BY CLAIMANT IN OTHER COUHTRIES
p Couny
certfi/ the above statements are true, correct and complete.
ASSESSOR USE ONLY
tand not exceeding 1(one) acre immediatey
sunounding residential improvements.
Otherlartd
Total land (line i plus frne 2)
DweUin9
Residernial imprwements
Garage
Other improvemenis
To[al improvements (line a through line 6)
Total value (Gne 3 plus line 7J
, I hereby cenity the above is we, correct, and
comptete.
� Verit}ing attion - Signamre at AuEitor
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19_ Pay 79 _
Lesser ol 7/2 Homestead
ValuaGon or 52,000
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(2I
(3)
(4)
(5)
(6)
1�1
(8)
use
TRUE TAX I ASSESSED HOMESTEAD � NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
OEDUCTION ALLOWANCE
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-. _ SLUT 100.%1 ,s.l !,-r1 tRL&tnfOLM 73-SA
.\r/ROVED BY'rktE BOARD OF MYm fists.9r ?tIS'RIBFD BY nn:DFPA&flCt OF LOCAL nns[B.'So].'E FINANCE IC 4.1.1-21.1.1
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 becomes
more beneficial,there is more incentive than eser for homestead fraud Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county goverment to better monitor homestead
filings.Ibis information will he kept confidential and can only be accessed by authorized county officials.The Depanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Gray, George C/Peggy Trust Life Est
103 N Jeremy Lane
Haubstadt IN 47639-8161
7375
George C Gray Jr.
103 N Jeremy Lane State Parcel Number Legal Description
HAUBSTADT IN 47639-8161
1f 1rr11rr rlrt�rrtt��t�r�rr�rr�rrr r��r�� ���� ��rr r�r�� 26-18-36-403-000.655-009 013-00655-00 WEST HGTS 4TH ADD 29
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PART 2: TAXPAYER INFORMATION
Owner First Middle Last
g Addr (number and street.city,state,and ZIP code) �S'nme ac property address /
.Son3 n�/
Spouse //'�/t First Middle,�, ,,� Last
Mailing Address(Number and scat citjL ZIP code) l game as pmpeny address
– — /03 AL �,r- --- .t�f�r-t�7_�n. 1183 9 u
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 Signature Date
PART 4:ADDITIONAL INFORMATION .
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