Homestead_Burkhart�
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STAfVDARD DEDUCTION
S�te Form SI73 (R6 / 1-03)
Prwrnbe0 by Me Departmmt of Local Govxmnent Finarwe
INSTRUCTIONS: See rewrao tlda br Ii�g ir�eburblyy,
� � , tiC�o
DEC 1 9 2005 /i
��e� cen1rti (i�t onV thpe�lns�t dnay ot March, 20
I(We) p' d as our principal place of residence ollowing described real property (or which a e�stea�Property T�-CiedF is hereby Gaimed:
� I(W ed ❑ Are buying under wntract �
1 Have a beneficial inlerest in the enlity that is liable for ihe property taxes on ihe property and th�t owns lhe property or is buying under a contract.
If buy'ug on traq, Fee Sim de owners name
s a - _ v e�-o
Recorda ofi whera p is recoMed
k�<_�svr..4..�.,.—�..=-.x�.�+� -�. .�... �r ��
Counry Tamship
� y� �_r/y �� L al de!
'.%Y�' /
H any portbn of Ne residential sWqure w Ihe land nat
ot ihe propeAy uti¢ed to produce income.
UO -
one (1) aae
County I Tavnship
I hereby certify the above statements are W e, coned and complete.
�dress (numbereiM sfreet, city, sfafe, 21P code) ./f _ ^
�.
Record number � Page
Q , ''i
� Is ihe oroperty in question:
❑ Real property MoWe Homo (/.C. 6f.1-7)
surrounds Ihat sWCNre is used b protluce income. tlesrribe the use and portbn
ToxnShip
'G`r,•'���?�.i'��,.�'i��w.`�,�'�,�_',�+�;; �n`;STANDARD:DEDUCTIONALLOWANCE*;��''".�'t."?��-�`�"rnf�.,,,�"y+�'izx"�..>��"�=��.'t�`a��`,`.�`,�'a��'''.r_-°.-u'
20_Pay20_
\ Le�ser of 1/2 Homestead � S
��\ w�no� or sas.000 � � \
Signature of Fudtv " Date signed
e
u
Gibson County Auditor
101 N. Main SVeet
Princeton, IN 47670
11984
STAiE fORM'l5M (0.1/&10)
nPPRp'EO Bl' SI�iE BMRp Of KLUIIVIS. YpV
l%FaSL'RFIIi00.NlS1A
t�FV1AVCE1Cb11-13d1
Individuals and manied rouplec are limited m ane hamcaced nandard deduccion. Ts che receipt of this deduction becoma
more beneficial, ihere is morc inremi�s ihan n<r for Aomatrad fmud. Homatcad (aud auus higha tu bills for all; �hcreforc,
HEA 1354-?009 requims'azparrrs who reccivc the homestcad standard deducrion to veri(y chat they arc�cligiblc to rcceiec thc
benefit md to pra�dc addiliox�el idrnlifqing information necusarv to ellou� couny gm�m�mect to bettcr moni[or homestead
filings. 71Ss information xill be kepi wnfidential and can wW be acccsur! by authoriied caunry afficials. The Dcpartmeu: of
I.ocal Grnsmmrn: Finance wiil use this infocmation ro crtatr tools �hat will help cowN officials elimirute Iwmestead (aud.
•� 1• •
TaxpaverName LowtionAddress
� Taylor, Jerri L '
Jerri L Taylor
4642 W SR 64
PRINCETON IN 47670
F ILE�D
NOV 9 2011
II�I �I I I� �II I I I�I
State Parcel Number
26-42�_��5�9_��
4642 W SR 64
PRINCETON IN 47670 �
(I I II� �II� II� II� III .
mh
Leqal Description
c�.M \' V
GIBSON COUNTY AUDITOR -
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,
0
.°v ri � u
Address (numbcr and svcct, ciry, statc, and Z[P code)
LiccauJStau m N�ber
Addras (I�umber and strcc4 ��tY, state, and ZIP code)
�.rity \umbcr (last S digit5) Drivei's LiansdStam ID \umbcr
5 digia)
F]
,�.�I �Qy 10� - �u r��--t-
� Same ss property addrus
Other (pleau spa:ify in Pert 4 below)
]Sm�
iddlc
o �
� Sarvc az property address
� O[her (pleau speci(y in Pan 4 bclow)
�V �
y...
undersigned certifies, under penalty of perjury, that the above and foregoing information is true and correct and that he or she is eligible to
+e the homestead standazd deduction on.this property. Each undersigned also understands that, by claiming additional homestead deducrions
+fully, he or she may be Gable for back taxes and substantial financial penalties.
�� g{�� = IJate � Telephone
.�,._:_..�G-�. _ �1 .�- �i-a-�- I I �