Homestead_Clark (4)�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
620
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fi�dividuals and �nurinf muplec arc limi¢d �o ore hnmevea�l aandaN J.�vlunion. As �ht �eceipi ol tAis dedunion hca�res
morc benennal, rhrrc i.. morc i`rcenme ilun e�er for homrscead f`aud. Ilomrs�eaci (aud causes hi�hcr iai bills tor all: thereiorr.
H!A 1333-30M requim taxprers who rtirise ibc hanesiead uandarJ deJunion io .erily tha� ihcy are elieiNe to rearne �hc
benefi� am1 m pmridv aJAiiional iJen�ii�'inc Infomuicon Mce.sary tu allux� county gm'emmrnt �o beuer mmi�or IwmrnaaA
nlin�. Thi> inio`maiion �cill br Aery cmlidentnl anJ r�n only L+e acc<v.eJ by awharizeJ rouniy officiais. The fkryvinnxm o(
I_ocal Gwcmnem PinaM< oill uu rhis iniormaiion �o ar<a:c ecvls iha� �.�iu h:lp cou�n� omcia� elimi�ie homcsicaJ irauJ.
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Taspa�•er Name Prnoerh� Address
Clark, John R/Laura R
John R Clark
745 W 350 S
PRINCETON IN 47670-9375
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State Parcel Number
2611-36-200-000.531-027
J
7i5 \Y 3i0 S
Pnncelon I\ -07670
Lesal Description
006-00531-00 PT W NE 36 2 71 1.50 AC
D-17
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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Ou�ner I First Afiddl< Las�
Ci�l �]C U (� C- Gl V' ��
'atc Address (number vnd itrm, city, s�ete, a�d ZIP code) �Snme us pmpem' addmss
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Sceul Sccuril} Numbn Qasi i diCiLS) Ihirds LicensdS�a¢ ID Number (Imt 5 diciL) O�hcr �pltue spcciF in Pan 4 below�)
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Spouu Firs: Middlc Last
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Mailing AdJress (NUmbcr and sVeeL ciq', s�ele, and ZII' cale) t� Same u propem adJrtix
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'��w 3 SUs �i,��e�o �jv ��76�70
Social Securiq� Number laz� 5 digiu) Dricd> License/SU[e ID Nwnbel past 5 dicits) O[ha (pleace speciF� in Pan » belou�)
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Each undersiened certifies. under penalty of perjun•. �hat the abovz and foregoing in(ormation is we and corrzct and that he or she is elieible to
receive the homesiead standard deduction on this property. Each undersigned al>o understands thzt, by claimine additional homestead deductions
unlawfully, he or she may be liable for 6ac:< taxes and substantial financial penalties.
Oxncr I Signaturc Date 1'clephme
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