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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION �
State Form 5473 (R2 / SA2)
INSTRUCTIONS: See reverse side forliling instructions.
FORM
HC70
YEAR
I(We) certify�that or�1�d� qQaBlch, 19
I'we) occupie our principal place of residen th Ilowing described real prop y tor which a estead Property Tax Credit is hereby daimed:
�(We) owned ❑ Are buying under contract . ///� �
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❑ Have a beneficial interest in the entiry that is liable for the property taxes on the property and that owns thaHr�p�ftj*oi �b[iying� q�e�a. r. ct.
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PROPERTY
Township
5 � � I Legal
3-/=/O 7. Do
If any portion of the residential strucmre or Ne lantl not ezceeding one (71 acre Ihat immediatety surwunds that swaure is used to produce income, describe Ne use arW ponion
ot Ne property u6lized ro produce income. _
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -� �
County Township County Township
�eby certity the above statements are true, correct and complete. Sig�namre o`t claim �
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AO e ber antl streef, ciry, slate, ZIP mde)
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ASSESSOR USE ONLY . TRUE TA7C ASSESSED HOMESTEAD NON•RESIDENTIAL
.VALUE VALUE - VALUE VALUE -
Land not exceeding 1(one) acre immediately , �
surrounding resideniial improvements. (�) `
Other land �p)
Total land (line 7 plus line 2� (3)
Dwelling (4) - . .
Residential improvements
Garage (g) -
Oiher impmvemenis (6) � _
Total improvemenis (line 4 th�ough line � (7) -
Total value (line 3 p�s line � (g)
1 hereby certify the above is Irue, CorreCl. and Signature ot Assessor � Date signed
complete.
Veritying aaion - Signamre ot Audi;or Dare signed
' - - � STANDARD DEDUCTION ALLOWANCE
79 _ Pay 79
Lesser of 1/2 Homestead
Valuation or 52.000 S �
Sig u f Audi:or Date sign
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
849
51aI£FOAN'tw�2'/fwl
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RIF UE�M1MEYfUF 11kAL f�R.Y`Rh"i iS:l�'CEIC�I.1-}_-�.1
Indiriduab and irt�rriN taupla are lunited to orc IromeMeaJ yandaN de[lu.�ion..4e ihe receipt al �hu dcduction 6ecmrce
morc 6enaficiaL thrrc is morc incrnme rhan rc<r (or homeiteyl fiauJ. Ilamcsrcsl Bawl causes higher tac bfllc tor all; �herefae.
HEA G-4:-?IX!9 requim mxpa�en who reteire ihe hanesiead smndard dnluction to .erity �hat they are elieiWe to rceei.e the
benefit aN tu pnn'ide ;kkliiional idemin'im_ fnfurma�iun Mcectan' �o allw' rount)' ga'emmrn� to bei�er muniior homes�eaJ
tilin�,�.'Ihis intarmatinn x�ill M Aryu mnGdemial anA nn nnly h acer: ud by aWhnrized rnunly n0icins. "fhr IXpanment nf
I.ueal Gm<mmcm Pimncc ��ill u.c this in(ormuion w crcme twls �ha� will hdn munrc ulTxialx diminmc humc.tcad fraud
Jimmy C/ Kathy L Lutz Edgington
R36ox51j
PrincetonlN 47670-8630
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Tasparer Name
Edgington, Jimmy C/ Kathy L Lutz
ia l First
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�cAdAress(numbclmidivc .city.sie�e.sndLlY�- 'ej— � - -"
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undersibmed cerrifies, under penalty of perjury, that the aboce and foregoing infurtnation is we and wrtect and that he or stie is elieible to
�e the homesiead standard deduclion on �his property. Each undersigned al;o undersiands that, by claiming addilional homestead deductior
.�fully, he or she may be liable for back taces and substantial financial penalties. �
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