Homestead_DukeCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Steta Form 5473 (R614-03)
Presuibed by Ihe Department of Local Govemmem Finance
INSTRUCTIONS: See �averse side /or �ling instnxtions.
A,
FORM �� YEAR
HC10 �
� L � �
��e) 4� � � � r � ���+UL�-% '' � '' certify that on the 1 st day o( March, 20_
I(We) occupied as our principal place of residence the foilowing described real property for which a Homestead Pr�� ��� hereby daimed:
❑ I(We) owned ❑ Are buyfng under con�ract GIBSON COUNTY AUDITOR
iHave a benefidal interest in the entity that is liable for the property taxes on Ihe property and ihat owns the property or is buying under a conUacl.
If byvg om m�uact. Fee SimDle ownefs name
Rerordefs olfice where conuaq is recorded
:�vfi!%"�t�.�`V�}���«^ 4 :'o-.5it�4�.°�'dr..i-`.'�5-._.�G'd
�'��
Counry Tavnship
�f any portion o/ Ne residentlal sW cture w Me Wnd not
of the property util¢ed tn produce irrcome.
��' I Is Ne properry in question:
❑ Real prop
Rewrd number
❑ Mobile Homo
Page
6 f.
(7) acre that immetliatety surtounds that swUUre is used b produce income, describa the use and portion
a. �bq�
.'�°-ar^ �a+� .;..-.�w-'4 -i�+a.t`--.a.��'�.ki"`�-5M t E-.?",c - ^a -- - .a, �.,;�- � >
�r �ASSESSORUSEONLY� ��' i TRUETAX�- t- ASSESSED�VALUE 3" HOMESTEAD�* NON-RESIDENTIAL����eT.��
c�, v::-�'.�+��-L'�$AG"�.py...<tiR;4�2�.,�°"z-,�3;. .,,�%3y4�-',��'� .�w�VALUE.:i ti�� _AT 100% OFiTN.»!r �y� VALUE� d�s ��:e3."`„aY'.`�VALUE �ix,�.kr.'�`�.i�'
Land not exceeding 1(one) acre immediately �vi �'�E�f'fc �ti'n�-��`�'��
surrounding residentlal improvements. � (�� �`�:`"��^��.'.7�)��� � �'°��-'��'w�--��"�'
Othei land �Z� .'-�����`�,-'����. ��".r��
�; n��'t'��
Tdal land (line 1 plus line 2) (g�
Dwellin 4 `�; ��4-°S�� 7°'�'�'�"�
�Rasiden6al improvements or Mnually 9 ( ) �"'����°-°"'�'-'�'�����
Assessed Mobile I Manufactured Home Garage �5) �,.����3��5`�.c:����
� =� =F
`S =�-"'�': -=�:,t
Oiher improvements (6) a r � = �
ir—��"-�.'`�t"��i"�.�
Tclal improvements (line 4 through line 6) (7)
kial value (line 3 phs line n (g�
I hereby certify fhe above is We, conecl, and Signature ofnsseswr Oate signed
complete.
VerifNng aUion - Signature oflwdiWr Date signed
�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
InJ�rWUals anJ ma��iN toupl� a�e limi�ed �o om homcvcad �tandaN dcAu.�ion. As thc rccrip� of ttiis deductan bccomes
morc bemficial, there is morc incrnme than e�nr (or homesteazl fraud. Nome..'teaJ &aud causes hi�her tac�bills tor all: therefae.
HEA 1333-3IX19 requim mapa�en who reeeire �he hanesreaJ standa�d Jeduction to rerify iha� �he}' are elfefNe w meene the
benefit anJ to p�m�idc m4litional identiiyin_ infomimion �crs'vn to allw� munty gmrmmrnt ro Naer monimr humes�eaJ
filin�. Iliis in(mmatinn will he Aryv mn�Idential and can nnly M areezuJ b� authnnzed rnunq� oRcinls. TAe Ikpannmm of
Local Gw<mment Fivntt will uae this intormanon [u cream [wls iha� aill h:ln �o�nn� ulficial> dfmiwve homcYCad (mud.
553
Michael A Duke
R3 Box 312 K
PRINCETON IN 47670-8590
�i�u��iu�i��n�u����u��n�u�i�i���n��in�n���iu����n)
Taapaver �ame
Duke, Michael A
R3 [3oz 31? K
Princeton 1\ �7670
State Parcel NumAer Le�al Descriotion
2('il 1-16-100-OQ3.625-027 U06-0362500 PT N� 16 2 11 2.969 AC
D-77
_ _--`/ ' —. . . . _ . _ . _ .'—'
This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the county
n
'ig Addras (numbcr nnd ;vcc� ciry, sta�c, and ZIP codc)
875 D�S� f� , s
31 Sceurity Numba (IaR 5 dieils) Uriver's Licen�eJStaie IU
��
Addreas (Number and slree4 cil}', stale, and "LIP code)
n
Qut 5 digiuj � Other
lJU e
$nme ns property add�¢
in Patt 4 bclow)
� Same :u p�operty addres;
ID Nwnbcr Qact 5 digits) � Ochcr (plcacc s{xciF in Part+ bclow)
rer.
Fach undersi�med certifies, under penalty of perjury�, that the above and foregoing infortnation is we and correct and that he or sFie is zlieible to
receive the homeslead standard deduction on this property. Each undersigned al>o understands that, by claiming additional homestead deductions
unlawfully, he or she may be liable (or back taxes and subsiantial financial penalties. I
O.�ncr i $irnal�uc I�V^ Tdcvhonc {
:��_
Sipu[ure
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