Homestead_DzienciolE R�R
e� ; CLAIM FOR HOMESTEAD PROPERTY TAX.
3��= CREDIT/STANDARD DEDUCTION
s
�; State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side 7or /iling insUUCtions.
^ ' FORM
HC10
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��FUT_ . . . . � -
YEAR
I(We) _� I" I 1 1 J�f ( �J�/E'if JCIO / certity that on the 1st day ot March, i9
��) occupied as our prinapal place of residence ihe following described real property for which a Homes d Property T it is he by imed:
u I(We) owned ❑� Are buying under contract _ - .-
� --n� �our T� n�1DlTOR
❑ Have a beneficial interesi in the eniity thai is liable for the property taues on the property and that owns th'e pmperty or is tiuying under a contract.
- - � CONTRACTRECORDED� � � � �
It 6uying on contract, Fee Simple owner's name ' - _ .
Recorder's oHice where contract is recordetl Record number Page
Parcel number
Leqal
PROPERTY DESCRIPTION
If �j dSrtibtf ot the residential strucWre or the land not exceeding one (1) acre �hat immediatey surmunds that
of the property utilized to produce intome. �
County
Atldress
PROPERTY OWNED BV
certify ihe above siatements are true, correct and complete.
ury, slate. ZlPwde)
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is used to produce income, descnbe the use
Township
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDEMTIAL.
.VALUE '�VALUE VALUE VALUE � -
Land not exceeding 1(one) acre immediately � �
surrounding resideniial improvemenis. (�) '
O;her land (p)
Total land (line 7 plus line 2� (3�
Dwelling (4) . �
Residential improvemenis
Garage (5) �
Oiher improvemenis (6) -
Total improvements (line 4 through lina � (7)
Total value (line 3 p�s line � (g)
f hereby certify the above is true, correct, and Signawre of Assessor oa�e signed
complete.
Verifying action - Signature of Auditor Date signed
��
� STANDARD DEDUCTION ALLOWANCE '
19_Pay19_ -
Lesser of 1/2 Homestead �
Valuation or 52,000 �
Si u ol Audit Date igned _�
,:�
Gibson County Audibr
101 N Main
PRINCETON IN 47670
„�,��a.,
1RFANAER W0.4 :Rln
InJividuals md rm;riN <ouples are limi�ed to ore home�tead avndaN dzdu�_uon. As ihe reretip� ot �his deduction hconxs
more beneficial, tMe is rtrorc fncentnx dun ner for hamo'rcad fnwl. Hom�s:rael fiauJ causes hi�M tas tills for all; iherefine.
HEA 13M1i-?IXYI rcquim uapa.en who rreeire the hanes�mJ smndaN dnfuction to .erily tha� �hry are clicidr to recei.e the
benefit aN to pnr'iJ< aikti�ional identiiyinc infurmatiun �ktt.sin� ro allou� caunrv garmment w Y.ere; monitor humrneaJ
filin�,�. This inlarmuion Mill M Aep ronlidemial anA can only h: acce�uJ br autlror¢ed rounp' ntTicial�. The Dcpannmm o(
1_ueal Govcmmem Pinance will ¢.c this information tu crwte 0.wls �hm n'ill hdn cvirin� ofiriala dimidne hermeamd fmnd.
664
Phitip G/ Diane M Dzienciol
244 Lake Inwood Dr
PrincetonlN 47670-8678
I�I��II���I�II��I���ill���l��l��il��l���ll��l��l��l�l��ll�l��l
T�ana��er Name Prnpertc Address
Dzienciol, Philip G/ Diane M
R3 6ox 130
Princemn IN 57670
State Parcel Number Leeal Description
26-12-06-201-001.435-027 006-0143s00 wcE IIJWOOD SUB DIV 10
— — —�/ — -- — .
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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g Addrtss (number and �m, cirv, sute, ar�d ZI P code)
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Snmc ns pmperty address
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undersigned certifies, under penalty of pepury, that the above and foregoing infortnatiun is we and correct and that he or she is elieible to
�e the homestead standard deduction on this property. Each undersigned al;o underslands that, by claiming additional homestead deductions
rfully, he or she may be liable for back taxes and substantial financial penalties.
I $iymenve Usle 7'clephone � �.
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