HomeMy WebLinkAboutHomestead_FreyCLAIM FOR HOMESTEAO PROPERTY TAX
CREDITISTANDARD DEDUCTION
Stata Fortn 5473 (R6 / 4-03)
Rdaihed by Ne OepaNnent d Local Gwemment Finance
INSTRUCTIONS: See reverse side /or (lirrg inshvctions.
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I(VJe) occupied as our principal place of residence lhe (ollowing descn
❑ i(VJe) owned ❑ Are buying under contract
' Have a beneficial interest in the entity that is liable for the property
1( buying on conirad, fee Simple owners name
Remrdels office where contrad is recorded
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= 4."htr`.c'�.T��i'i�. �+P.A!i2.�: ��`�J..^,•Y � :T n�}'
County Toxnship
FORM
HC10
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Y�.J
YEAR
certify that on the 1sf day of March, 20_
property for which a Homestead Propehy Tac Credit is hereby daimed:
MAY 1 9 2006
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Tacing di5tricl (city, fown, township)
property or is buying under a wntract.
Record number � Page
�- D^' w- � I �qga e uon ' Is the property in quesfion:
/ 1J ]L •4�
�/Wf/ 1 ,3S I��1 s� ❑ Realproperty ❑ MobileHOma(IC 6f 1-�
of Ne resitlentlal sWClure w Na Wnd not exceeding one (1) aae that immediatety sunounds that sWCture is used b produce income, describa Ne use and portWn
y utilize0 to produce inwme.
L�.���.ASSESSORUSEON Y�'-�"t'3�. N.;�TRUETAX'�` ASSESSED'VALUE r HOMESTEAD " yj N.O•N=RESIDENTUIL �
�Gt+S.: �.y�>��_'•' ff .�rY�'"�'_��_i<�a�.t� YI'J�...VAI:UE."k?�z..� 4AT.100Yo'OFFk�TTV€.e»x'1�VALUE�.��i�{'s`�i.-7e?.'s..V/iLU�i::._`;��
Land not exceeding 7(one) aue immedialely �"--�,-�.;��- ; `����;�
surzoundingresidenUalimprovements. (�� �-"��/tzy _.`` R �Y���;;'
Other land (2) t ��Y'� ��
`�a�:;�'�
Tdal land (line 1 plus line 2) (3)
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Dwelling (4) ���w'--�r�—`�u� ����-�a��y,
�Residentiel improvements or Mnualty --' ^' �6 � `� - `
Assessed Madle / Manufaclured Hame Garage (5) ��5��`'�ejt.��r'y�:Y : e,.�`-°r��.,•'?
.�..�`.��':i�' � ° �"�':a: mw.3��-'�
:�;,.,�,�;.3,�=
Other improvemenis (6) �-ti_ �.=:." "`= �t,�
�`�z.�-::..s
Tdal improvemenis (line 4 fhrough line 6) (�)
T[lal value (line 3 phs line n (8)
I hereby certify the above is We, mned, and Signawre orAssessor oa�e signed
complete.
Veifyifg aclion - Sig�ature otlwditor Date signed
SfATE fORN SJX9 (R'J8-0l) Tf;FASURER FORAi�S1Al
MPROVEO BY S7ATE BOARD OF ACfOUYiS, 2009 PRFSCRI9ED 9V THE �EPARTME\T OF IAf.\L GOVFANMEYI FIYANCE IC61.1-�:.d.l
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
�uctiou becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
causes higher tas bills for all; therefore, HEA 1344-2099 requires taxpa��ers who receive the I�omestead
standard deduction to verify that they are eligible to receive the beuefit and to pro��ide additional identif}'ing
informatiou uecessary to allow counh� gover�ment to better monitor homestead Tiliugs. T6is information :
will be kept confidential and cau ouly be accessed' by'authorized'couuty officials.:The Department of.Local °
Governmeut Finance rvill use this information to create tools that will help county officials �liminate '
homestead fraud.
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Taxoarer \ame Prooem' Address r� � Slate Parcel Number Lesal Dncriotion:
Ruth A[m Frey 'r5 �� � � l/�� �, °2 O� `� ' 26-04-35-300-000.606-027 00G-0OG06-00 Pl' SW 35 1 11 1 AC
p Princeton IN 47670 �� �_�
Comp(ete and return to: � ,
GIBSON COUNTl AUDITOR 101 N.�1A]N PRIrGETO� L\ 47670 -- --
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Qma 1 First AtidNe La9
U-7- N l� �!� �
Mai4ep Apdress (nurtE¢r an7 Street, aty. sfate arb ZIP Wtle)
y� � � Same as poqxty aONess
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SodalSe(vnry Nuireer (bst 5 Olplts) Drrvefs Lirense State ID NurtEet (last 5 Alplts) sfx. ONer (p� W�+�Y in Part a Eelo.v)
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Spuise First A4dEle � , last
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MaJirp AtlNess (num0a aM Weel ary. state ariE 21P mtle) �$amC as property aEOress
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sadai senairy Nwmer (es� 5 ak��l - ori.ers ucrose sa�e io r+unoer (nsc 5 eq��s) s�^ onc lpease sc�ry in re1 a oeio.vl
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Each undersigned certifies, under penalty of perjury, thai the 2bova and fwe9oing information is We and correct and that he or she is eligible to receive the
homestead sfandard deduction on this property. Each undersigned also understands that, by daiming additional homesiead deducdons untawfully, he or
she may be liable fw back faxes and substanUal financial penalties.
Pma 1 Si9�we Date
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