Homestead_FortnerdE —'VR�q CLAIM FOR HOMESTEAD PROPERTY TAX � � FORrn AR
a���; CREDIT/STANDARD DEDUCTION _ HC�o �
�;� • State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side 7oi /iling instructions. �_ �
Counry
PROPERTY OWNED BV ClA1MANT IN OTHER COUNTIES
certify the above siatements are tme, correct and wmplete.
(number and streeG ciry, state. ZIP oode) ^
daimant
�%�
Township
� � TRUE TAX ASSESSED HOMESTEAD NON-HESIDENTIAL
ASSESSOR USE ONLY � VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvements. (�) -�
Oiherland (2)
Total land (line 7 plus line 2� (3)
Dwelling (4)
Residential improvements ,
Garage �5) � '
Other impmvemenis (6)
Total improvements (line 4 through line � �7)
Tmal value (line 3 p6s line 7) - �g)
I hereby certify ihe above is tme, coveci, and Sgnature ot Assessor Dare signed
complete.
'�ying action - Signamre of Autliror Date signed
79_Pay19_
Lesser of 7/2 Homestead
Valuation or 52.000
STANDARD DEDUCTION ALLOWANCE �
3
=�°� - 93
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Gibson County Auditor
101 N. Main Street
Princeton, IN 47670
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,UN 7 20tR
19J'ASIRFA fOIMRI�
APPIIU'FD B\
Indi�iduals and mamed cauplw are limircd m one hommead standard deductioa As ihe rcceipt'�o! this deduction bemma
mort brne(rcial, ihere is more incentive �han ocr for homesteed (nud. Homestead (rzud cauus 6igha u.i 6ills (or all; �hercfo¢,
HF.A 1354-?009 Icqnires uxpa�xrs wta recene thc homcstead standard deducoon to .ttify that th<y are eligible m recen< the
bmefil and to prrn�ide additional idrnufying informntion nccesmry to allow' cwmry gm'emmrnl tu betta monitor homestead
filings. llris mformuion uill bc lept mnfiden[ial md can only bc accesud W auWorirzd county ufficials. The Dcparm�rn[ of
Incal Gmxmment Fin2nce x�ill use Ihis infomtation ro crtate mols thm will help counp' officials',eliminate homesiead fiaud.
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UN�Y �� ��
J�( I�EQame L Fortner
9T1� N
PrincetonlN 47670-8646
I'���I'�I�I'�II"�I"��"I�'��I��I��II��11���11'I����I�I�IIII�"'
Taxaaver Name Lowtion Address
Fortner, Jeffrey D/ Elaine L �
X971 E 2(10 N
PRINCETON fIN 47670
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II01�I11��II�111I�a11�11�1100111�i1 �il I�DIIDII�Ii�1111011I01III Id�ll�ll�l�f�lll III
State Parcel Number Leqal Description
26-05-40-215-000.57&02� PT LOC 2751 10 5.37 AC C-1
' f rm MUST be returned to Coun Auditor's o�ce. �
This o ty
Please do NOT send this form back with your tax payment to the county treasurer.
� e��✓e
C� �, �, c�
,ddrtss (¢umber mmd stree4 ciry. state, and Z[P cade)
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Same as property addrtss
Otha (pleau spxi(y in Patt
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iling Addless (Numbcr and srteet ciry, staee, and 7.IP code) �� P�P�nY ��S I��—
c�i --� 1 � �3-0 o rJ P r�;h cA—�--,� ��✓ Y 7 6 7p I
;ial Securitv Number (lut 5 dieiul . Drivers License/Stau m Number (last 5 digits) Other (pleau spaify in Part 4 bclo
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�IN
undersigned certifies, under penalty of pery'ury, �hat the above and foregoing information is true and correct and ihat h� or she is eligible to
�ue the homestead standard deduction on this property. Each undersigned also understands that, by claiming additional � omestead deductions
vfully, he or she may be liable for back taxes and substantial financial penalties.
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