Homestead_BrinkCLAIM FOR HOMESTEAD PROPERTY TAX F � : YEAR
- - CREDIT/STANDARD DEDUCTION H�i � r . � .
t � State Fortn Sd73 (RS / 1P07) �
�•� Prescribed Cy the Departrnent of Local Govemment Finance �,,��p q
INSTRUCTIONS: See reverse side /or (ling instructions. 11fU�.•1 g LQO�
� '� `�"� `�a�"'� ' ��" CERTIFICATI �STATEMENT '�'t''�' - �, �'"`-�y "x
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�(we) `f' • certiry that o�T���t�`st day otMarch, 20 r',
I(We) occupied as our prindp lace of residence the (ollowing described real property tor which a Homestead Properry Tac Credit is hereby daimed:
� I(We) owned ❑!ve buyirg under contrad �
�Have a benefidal interest in the entlty that is liable (or the property taxes on the proparty and that owns the property or is buying under a contrad.
If buyug on contrad. Fce Simple owners nama
Recadefs olfice where mnirad is recorded
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County Tawnship
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Parcel num6er n_ n 1 dA:
If eny poNOn a/ the resitlentlai atructure w Me land not esceedinp one (1) acre thet
o��a�� b `�°°�� �o
bb(�
Is ihe
wrrounds
Record number
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Real Oroperty ❑ Mobile Homo
ire Ls used to protluce inwme, desvib
Paqe
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uae and portbn
��,.s���� -����:���':`.STANDARU'.DEDUCTION�.au:owqricE ���,.'��:��i;.-?str"���'-�t�'.�.���
20 _ Pay 20 _
lesser of 1/2 Homestead
Valuation or $6,000 g
SignaWreofAud'rta " Datesigned
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
TRFASUI!&Po0.4:11.�
nrrrzrn'en
IndiriduaL-i avJ rturriN trouplo are IimitN Io ore honre�eaJ aundaN Aeduc�ion. as �he rtttip[ of �hi� deduction bttonu�
more beneficial, thzrc is morc incrn[ne than ever for homnrcad fraud Ilome�ead fmud nuus hgher Ia� bills (or all; thertFae.
HEA 64i-2009 requ'ves u�pryen ..�ho recci.c ihe hanesreaJ aandard �vluaion w reri(y ttut tAey art eliciMe w mcei.e ihe
benefii anJ ro p�w'idc additional idemiiyine inWrm:niun neces�ary ro allw� counrv grnemment �u betrcr moniror homestt:d
filin�y. This in(armmion xill 6e Aryu mnlidential and esn only M acttssnl by awMrizN rounly ofTicials. l'he Ikpanmmi n(
Local Gm<mmrnt Finaerce uill u.c �his informaeion ro cream twle ihat o�ill hdp counrv officials eliminam humcsicad haud.
350
Bruce C Brink Jr
-�-'���=�-�/da� it iou �J
PrincetonlN 47670-8547
�i�n��ni�i��u�ui���ni�n�u�i�n�n��ni�i�i��ni��i��n�
Taxoaeer Name
Brink, Bruce C JdRebecca S
Propertc Address
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rai�c��os i� a�e�o
State Parcel NumAer Lesal Description
26-11-01-200�004-302-027 006-Oa302-00 PT W NE 1 2 11 5.716 AC
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This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
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Oancr 1 Fim Middle Last
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ilme Address (number mid iueet, city, smtc, and ZIP code) �Snme as pmpem address
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$ocial $
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Spoiue Fim Middlc Last
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Mailine Addre55 (Number anJ strttl ci�)', stale, and "LIP cotle) Sarne as pmpeny addresx
Social Stturity Number (lazt 5 digits) Drivefs License/Staie ID t.umber (las� 5 digits) Oeher (plcue specify in Part» below)
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Fach undersitmed certifies, under penalty of pequry�, that the abo�•e and foregoing informa[ion is we and corrzct and that he or she is elicible to
receive the homes�ead standard deduc�ion on this property. Each undersiened al>o understands that, by claimine additional homestead deductions
unlawfully, he or she may be liable for back taxes and�substantial financial penalties.
O..ner 1 Sirna � Date 7'clephonc
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