Homestead_DonovanCLAIM FOR HOMESTEAD PROPERTY TAX YEAR
CREDIT/STANDARDDEDUCTION
17 V, State Form �73 (R6/4-03) FT) I
Prescribed by the Department of Local Government Fmanc-.-
IMSTRUCiICINS: See reverse side for filing ins/1111:1in,is
MAY 0 2 2005
w +y_'CERTIFICATION STATEMENT;.�
certify that on the 1sto Ms�120_
1 (We) occupied as our principal pla" residence the following described real property for which a Homestead
❑ ,I(We)owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
County Toxnship Taxing district (city, town, township)
R I be
Is the property in question:
q
cy QVh ❑ Real Property ❑ Mobile Home (I.C. 61.1 -7)
4
If any portion of me residential or the La;.. ........ds that structure is used to produce imoorne, describe the use and portion
of the property utilized to produce income.
ROPERTY.OWNE6BYCLA111A414T INbTHER'COUNTIE
ONTRACT!RECORDED-,t..
Tmnship
County Twvnship
If buying on contact, Fee Simple owners name
na of claimant
^sfnuun^�andsheet
- Qi
PRIM k4NO-,� - rF?T(Q1Pn
q
$
""""VALUE'
Land not exceeding I (one) acre immediately
Recorders office where contract is recorded
Record number
Page
County Toxnship Taxing district (city, town, township)
R I be
Is the property in question:
q
cy QVh ❑ Real Property ❑ Mobile Home (I.C. 61.1 -7)
4
If any portion of me residential or the La;.. ........ds that structure is used to produce imoorne, describe the use and portion
of the property utilized to produce income.
ROPERTY.OWNE6BYCLA111A414T INbTHER'COUNTIE
County
Tmnship
County Twvnship
I hereby certify the above statements are true, correct and complete.
na of claimant
^sfnuun^�andsheet
- Qi
PRIM k4NO-,� - rF?T(Q1Pn
q
I'd I
W WASSESSOR -USE ONLY 2
;jTRU E-TAX
AS
-
�5-
MESTEAD;,'
e�'i--5iy��Nb�N-'RESIDENTIAL:�'.i,-�
oft'!R --
WYAZPiv-_�
Lesser of 112 Homestead
Valuation or 535.000
$
""""VALUE'
Land not exceeding I (one) acre immediately
Date s signed cd
a _e
5 - a _05'
surrounding residential improvements.
Other land
(2)
ZIA,
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
K Wa,"
Assessed Mobile I Manufactured Home
Garage
(5)
R7 r' l
Other improvements
(6)
Total improvements (line 4 through line 6)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
IVerifying action - Signature of Auditor
-
Date signed
t I U
ft4 D
STANDARM EDUCTION ALLOWANCE`0.
... . .
20 _ Pay 20
Lesser of 112 Homestead
Valuation or 535.000
$
Signature of Auditor
06 NA�3,
Date s signed cd
a _e
5 - a _05'
t I U
r
2 •EVE FORM!OM ONO MEASURES I O MEASURES FO0.VZIA
II AEPMT'ED BY STATE WORD OF V'nB:\xt.aVM n{r.RAfBED BY ME DEPARTMENT OF LOCAL C{T=LYMG.T FINANCE feIsEL--J.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
1 more beneficial,there is more incentive than nor for homestead fraud.lhomestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they am eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kepi confidential and ran only he accessed by authorized county officials_The Depanment of
Local Government Finance will INC this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Donovan, Donald R/Max J
215 IA'2nd ST
Hazleton IN 47640
85.— — . _ _ _ _ _ _ _. _—__ _ .-- .
Donald R/Max James Donovan
P O Box 215 State Parcel Number Legal Description
HAZLETON IN 47640-0215
ItlttlltttlllltttlttllltttlltrrrtliIiitllllllrtrrllllllrtlllll 26-02-29-200-00a097-019 014-09097-00 BR 1ST ADD 24PT/1
/
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
,4)1- .1A PIrs Oonovctn
— e AddFess Mumbe and stECtt,Fite,state,and ZIP code) -- - --"— - - — E'Same a property&Slums -- -- ---- - --
0, (. Ro' sI> IIAalc-1-on 3Yj/. L17 t yo
, -
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sane
PART 3:CERTIFICATION
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 1 Signature Date
Spouse Signature Date Telephone
( )
PART'4: ADDITIONAL INFORMATION