Homestead_Burris (3)<If ��R
a� _' g CLAIM FOR HOMESTEAD PROPERTY TAX
i��: CREDIT/STANDARD DEDUCTION
.�.;;� State Form Sa73 (R2 / 5-92)
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INSTRUCTIONS: See reve�se side !or tiling instructions.
our principal place of res�nce the following described real property
FORM
HC10
YEAR
�s5�
that on the t st day of March, 19 / T
Property Tax Credit is hereby claimed:
I✓ I(We) owned ❑ Are buying under contract /./ ���
I.Ci�rt.x¢�
❑ Have a beneficial interest in the entity that is liable for ihe property taxes on the property a� tlrot� ��rS ro erty or is buying under a contract.
� � CONTRACT RECORDED . �
Itl buying on contracL Fee Simple owner's name - . - , •
Recortler's oflice where contract is recorded FeCOrd number Page
County
PROPERTY DESCRIPTION
Tazing district (ciry, town, township)
Partel number Legal description
006 - Ob �o �- ao �,t n!E (o- .2 -� o . 86 EIc.
It any portion of the resitlential sVUCmre or the land not exceeding one �i) acre tha� immetliatety surmuntls that struc[ure is used ro produce income, describe the use and portion
of the properry utilizetl to produce income. _ .
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 1(one) acre immediately .
surrounding residential improvements. (�)
Oiherland (2)
Total land (line 7 plus line � (3)
Dwelling (4)
Resideniial improvements
Garage (5)
Other improvements (6) '
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g)
I hereby certify ihe above is irue. CorreCl, and SignaNre of Assessor Date signed
camplete. �
'Nrg action - Signa;ure of Auditor Date signed
STANDARD
19_Pay19_
Lesser ot ll2 Homesiead
Valuation or 52,000 S
Sgnature o� Autlitor
•
,-
Gibson County Auditor
101 N Main
PRINCETON IN 47670
2243
John T Burris
1390 N SR 65
Princeton IN 47670
S1 VE ft)Ftl!JM�R'/ �Vr1
0
fREY[W�RIpYi11f
1RfA[OAERf00.VTS1A
InJrviduals and ma:�iN couph are IimiicJ io ore hmme�ead �and'nN �kdu:�itm. As �he receipt of ihi� daluction betonm
more bcneficial, thrre is mwr incrn:ne Uun ner for homr��ead fr�ud. Ilome'rcsl fraud causes hi�hrr ta� bills lor all: the¢fnc.
H!A lia3-?IX!9 requires uxpa.crs �ho rccire ihc hacestead uanAard ikrluction in rerilv tha� �6ey me cligiNc �o mcene tM1e
brnefi� anl ro pnxiJe �fi�io�ul iJrntiiyin� in(urmatiun �ecr.<ary tu allw� counn� grn'rmmrni �o betrcr moniror Mmesiea0
tilimy+.'ITis infmmmion will he Aryv conlidemial anA ran onh� M: aceeiml Ay authomnl cnunry nlTcinls.'ITe Ikpannmm nf
I.ucal Gmemmem PinaM'< ��fll u.c this in(ormazion w ercate twis that will hdn vu�o� uffrials diminam Mmc�ral Baud.
Tu�naver Name
Burris, John T/Emily Ann
State Parcel Number
26-12-06-100-000.70&027
V
Prnpertc AJdress
R3 l3ox I51 (� �
�C
Princemn I\ i7670
Leeal Description
006-00708-00 PT NE 6 2 10 .86 AC
D-10
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O�.�ner I First MidNe Lasl
a N iJ �M o � H; �n o2�, I.i
' iiu�g i.dJr.a� (numltrm�d s��.c:, city. catc: wd Z:^.cdc)' _ _ _ '__ . _ _ .. � 5°mc cs pm•t�._•m eddr�..' ' . -'
).3�►D r� S-�A�� �2� 65 �°n�N��7o�, z� ��G�io
Social Securiry' Numbr� (last 5 dieiu) Dricas Lica�se/Siate ID Nmnbcr (las� 5 digiBj Other (pleaSe specify in Part 4 below)
(-
Spou;e * First /� Middle Lut
CMII�i NNN� �1�al�R)�
Mailine Addre.ss (�umber and �vec6 ciiy, smle, and "LIP coik) n �$ume �u propeny ad�as
IJ\ � I V SyTI �;C V\�V b� V O`�IJ�.��W`�� �IV I� b I V
Smial Stturity Number (laz� 5 digits) Drivers License/State ID Nianber (la;� 5 dieits) Other (pleace s{KCify in Pan 4 below�)
�-�`
.. . ,
Each undersi�med certifies, under penalty of perjury, that the above and Poregoing infurtnation is we and wrrect and that he or she is elieible to
receive the homestead standard deduction on this property. EacA undersicned also unders�ands that, by claiming additional homestead deductions
unlaa-fully, he o: she may be liable for back ta[es and substantial financial penalties.
Owna 1 Sibmenae � . UaL^ 7'elephone
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