Homestead_Evans,� rt1� � CLAIM FOR HOMESTEAD PROPERTY TAX FORM F1 1'EAR
= CREDIT/STANDARD DEDUCTION HCta
'� � � J SUte Fwm 5473 (RS / 10-0i � �
Prescribed by the Department of Local Govemment Finance ��
INSTRUCTIONS: See reverse side /or (ling inst/uctions.
��^`.:.'"„ ""yyy� '.-" .. .,.=�'y+ �.r-���ai-�:`�CERTIFICATIONSTAlEMENTitr',_ --`��:�"Y - '-� �` �Y_�-i-Y'4�tu.-�.�
ri:=•u" �� i� s '7+'.� �C,is�'"�'Ssr.- , . .. _ , .. _ �... __ . � ?ca."3L-'{Y 4."?�^ �.S � �$' .'3"�r ni�. a-:._ : . �- •
�i ��e) `� � certi at on the 1sl day f Mar�ch, 20_
� I(WE) occupied as our principal place of r dence the following described real property for which a Homeste P perty �ed' ' hereby ai d:
I�Q i(We) owned ❑ Are buying under wniract GIBSON COU Tv q��017��
,,��Have a benefidal interest in the entity thal is liable for the property taxes on the pmperty and that owns the property or is buying under a contract.
If 6uying om m�Vact, Fee Simple ownefs name
Recordefs ofica where conVad is remrdetl
Tamship
Legal description � Is the
Record number � Page
pmpeny ❑ Mobile Homo (I.C. 6L7-7)
identlal sWCture or Ne land not e�cceeding one (1) aae that immediatey wrtounds that swciure is used co produce inwme. describe the uu and portlon
tn Woduce income.
'- ':tx '1 s.`5 �r '�:!.e� R ri �' ;-"�."-:rn
?+•_�z�.'�r��� �47pi�".�`�`F��i s��STANDARD;DEDUCTION�'ALLOWANCE.-�'c�„�'�ru ,,.`t +���w��'-w'_'_s.�w�.7�`,ss�s��sr� ._�.�..?X:''
20 _ Pay 20 _
Lesser of 1!2 Homestead
Valuation or $6,000
S
Sgnature of Niditw Date signed
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Gibson County Auditor
107 N. Main SVeet InAindual> anA marn��l coupin mr limnea io nne honR�a� >iarwra arnuctwn. .1 mc recnpi o� ;n
Princeton, IN 47670 morc hncticul, iFK�c is mure fttrn�i�c Ilun ertt (or homtn� nd (nuJ. !IomcA;ad Gaud tavas ii�hcr u�
r���� Hlid 137S-20fW requiro tuP�•rn wtro «e:ire ;hc homnmaJ >tanJacl deduction m.erifi� tF.a� �hey arc
p••� barcfi� anJ io prmiJc aldiiivaal idcmihing ir.lrem�iion nc:cs�n� io allow countp em'cmrtrcn� �o bai
Jl liliis.. Thi. infarrtu�ion will br l.cp confid��nial znd can only br at<.srJ by authurizeJ counrv olticia
MAY 10 2012
— C 'J N�y ,
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� GIBSON COUNTY AUDITOR
1469
Donald Evans -
4081 W Split Rail Ln
PRINCETON IN 47670-8443
II��I�������III�I�I����I'�'�IIII�I1��'���I�����I�II1�'��I'I�����I
Taxpaver Name
Evans, Donald/Julie
II�I�III��III �II I�II IIQI I��IIII
State Parcel Number
26-11-09-300-003.917-027
anlucuun brRxne�
I. (ur alh thacfurt.
eiMe to rmeict tht
m�niwr hon;cacad
The Depanmer.t of
4087 W SPIIT RAIL LN
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PRINCETON IV 47670
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Wlulul I IIOIu II QII Ilulul II II
M C ROBERTS OLC
9 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 1
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nna � ci � �.
Addrtss (number and �ueet ciiy. s�a:e, and ZlP code�
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xnd saeet, citp, state, and "l.IP code)
Numbcr Qast i
ID\c��cr Qy:>digi:s)
Urivds LiccnsUStatc IU
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Su¢
as propeny add�ess
u pmpcny add:ess
Other (pleue sper:fy ir. Pan 4
RD LOT
urer.
mdersiened cenifies, under penalty of perjury, that the above and foregoing informntion is true and correct and that he or she is eligible to
e the homestead standard deduction on this propeny. Each undersiened alio understands lhat, by claimine 2dditional homcstead deductions
fully, he or she may be liable for back ta�ees and substaniial financial penalties. . �
1 $ig�¢mre Date Telephoae
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