Homestead_Campbell (5)e� �°�a, CLAIM FOR HOMESTEAD PROPERTY TAX
s��;: CREDIT/STANDARD DEDUCTION
�,;� � Siate Form Sa73 (R2 / 5-92)
�sTi
R �' .EAR
NCiO`�
.� Q �9 .
INSTRUCTIONS: See reverse side for7iling instructions. r) }� y
l�t3� .(T . /{7�i �,�,r:
� � - CERTIFICATION STATEMENT� . ' AUD�'�(�R 0 '
e) _� ,�fLSLiL.�� � cenify that on the lst day of March, 19
It) occupied as our prin ipal place of r ide e ihe foilo ' g described real pmperty for which a Homestead Property Tax Credit is hereby daimed:
I(We) owned ❑ Are buying under contraci .
Have a beneficial interesi in the entity thai is liable for the property taxes on the property and ihat owns ihe property or is buying under a contraci.
COMRACT RECORDED � -�
It buying on contract, Fee Simple owner's name -
Recorder's oNice where contract is recorded Record numher Page
Counry
Parcel number
T..�/' �
' � PROPERTY DESCRIPTION
Township Tax"�ng district (
Legaldescriptlon
lownship)
It any portion of the resitlential swcwre or the land not ezceeding one (1) aae ihat immediatey surrounds ihat swcWre is used to produce income, descnbe the use and portion
ot the property utilized m pmduce inwme.
� ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL,
� VALUE VALUE VALUE � VALUE
Land not exceeding 1(one) acre immediately
surmunding residential improvements. (�) - -
Otherland (z)
Total land Qine 7 plus line 2� (3)
Dwelling (4)
Residential improvements .
Garage (5)
Other impmvements (6)
To�al improvements (line 4 through line � (7)
Total value Qine 3 pbs line n (g)
I hereby tertify the above is Irue, correCt, and SignaNre of Assessor Date signetl
complete.
ying action - Signature of Audiror Date sgned
i
19_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000
STANDARD DEDUCTION ALLOWANCE
S
oi Autli;or � Date
Y �
, �I�iEF00.M�!MIM_(f✓+1 MASU�.FAf00.4i}IA
�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
�5
Jerry D Campbell
1221 N Main St
Princeton IN 47670-8665
IndiriJuaL and m�rriN wupla a�c limiitd ro om homeuesd �andaN �4du.�ion. As the rmtipt ot �hi.. JcAunion Mromcs
more beneficial, therc is morc incenme tlun aer (or M1ome.'rcad fnud I Iomo�eaJ fmud causo higher tac bills for nll: there(arr.
HEA 13-03-I(NW requves usp.m x�ho �cceirc ihe Munes�mJ sundard deduriion m.�erify �fut tM1ey are eligiMc w mcci.. ihc
benefit aN ro pia'idr aAAitional iJrntifyinc inturmatiun Mm'vrv to allw' counrv gaemmenl ro better moniror homrsrcnJ
filinp. This inlormalion will 6e l.cpl eonlide�Vial and nn nnly Ix: samseJ by aWMr'vn1 enwl�� n(Twials. The Ikpannrcm of
Lucal Gm'emm<m Finmrce ��ill m< �his iniomution ro arcate twls Ihat �rill h:Ip cwnrv ofiaiaL. climina�e h�xnesicad fraud.
''' ,, ,"
���u��in����u�ni���ui�u��i��in��i�i�i��n�i�in���i��i�
Trxoarer lame
Campbell, Jerry D
�
Prnpert�• Addre�s
Wcll q 06-109
PrincetonlN 47670
%��C�
6�
State Parcel Number Leeal Descriptian
26-12-06-104-000.499-027/006-00499-00 PT NW 6 2 10 2.059 AC
/ D-1
�
1' 1
Owncr I �J first / Middl< /�CZ/n.% _" Lut
�i`-G.Zt 1 /'�C�. L
// .J
g Addrev (number nnd sacec ciry, stare, and ZI,P �co�d-e) ,% � Some ac pmpeny oddmss '
/ 2 2 / %Z�� �%iwr /,n'ze� j O"i:�!r�� , � � y7�%�
$ocial Securil}' Number (last i die�LS) Umers License/SUte ID Numbcr (lau 5 di�ib) Oiher (plcise sptti( in Pan 4 below)
Spou,e ' First Middlc Last
�'°.�- � ��...����
Mailing Address (�umbcr and sVee4 ��y, s�a�e, and "LII' wik) /� � S�me:a p`opem adArec
� a a"� �o� /�'r �r= /-L'� / �� . � � � 7� %1�
Social Sccuriry Numbcr (lact 5 digi�s) Drivtt's LiccnsdStatc ID Numbcr (la',� 5 digits) Otha (plcasc speci(y in Part: bclow)
�- 5� .
. . �
Each undersigned certifies, under penalry of pequry•, that the abovz and foregoing infoRnation is we and colrect and that he or she is elicible to
receive the homestead standard deduciion on this property. Fach undersiened al>o understands that, by claiming additional homestead deductions
unlawfully, he or she may be liable for back taxes and substantial financial penalties.
Own<r 1 Si6maLUe Dete Tclephonc
�� ����� y/� �,
����.���
„ , �� ,