Homestead_Gomezi��'��" - CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
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� e State Fortn 5473 (R2 / S92)
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INSTRUCTIONS: See reverse side for filing inshuctions.
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YEAR
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• CERTIFI ON STATEMENT
I(We) � M� � • �� c i that on th t t q 9_
I(VJe) occupied as our principal pla residence ihe following descnbed real property for which a Homestea P SON C� t�sptlL��9�laimed: -
❑ 1(4Ve) owned ❑ Are buying under contract G�g '
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACTRECORDED
If buying on contrect, fee Simple owners name . -- I
Recordefs oKce where contract is recortletl ' Record number , Page �
PROPERTY DESCRIPTION
Coun Township Taxng tlist (dry, town, towns � 1
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Parcel n ber �O Legal tlescription �
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It any portion of Ihe residential structure ar Ihe land not exceeding one (7) acre ihat immetliatey surtounds ihat swcture is used to produce income, describe the use antl portion of
ihe properry utilized to proauce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES �
Counry TownShip Counry � TownShip
Signature of daimant , `c/;�y�
�,ereby certify the above statements are true, correct and complete.
Address (numf�r�d gtree6 ciry�e(ate. ZIP � • `
(� ��}eC lJO�c 3 8 Q ,�eE-TO� I��� S� ��7 8
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately �� �
surrounding residential improvements.
Other land (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements .
Garage (5)
Other improvements (6)
Total impmvements (line 4(hrough line 6) p)
Total value Qine 3 plus line 7) (8) �
I hereby certify the above is true, coneci, and Signacure ot assewr � oate signed
complete.
Verityinq action � Signature ot Autlitor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
u ion or $2,000 �
Signamre of Autlitor Date �gned
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
3412
IndiriduaL� anJ ma:riN couplec arc limnad m ore home..tcad �tamlaN JNunion. As ihe �ttript ol ihii dedunian becmce�
morc beneficial, there i. marc ineenmr tlun e�cr for home.�eaJ fiauel. I lomesead fraul nu� higltr ta� 6�ills (ur all: fherefae.
H!A Ii�J-2009 requim �a�paren hho reccive ihc hanes�raJ smndarJ JeJunion m verilv �hai ihcy art oligiNc �o mcei.e ih.
benefii aml la pnr'iJe :uWitiunal iJentiipfn_ infum�a�iun necr.'sin� ro allw� county gv:rmmrnt ro be�te- muniiur homeste:d
fili��. �Iliis inlnrma�ion will 6r tary mnfidemial afM can nnlr h� acce:.eA M1�� autMriznl roumy officiai � 7Te Ikpannunt n(
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I.acal Govertnnem Fi�um'c vill ua this in(nvnuiun t�+ crcom 0.ds ihat will heln �mn' uffxiaL. elimmate humestead (raud.
Mike A Gomez
350 S 180 E
PRINCETON IN 47670.8964
���n��in�i��n�ni���ni�n�i�i�in���n�n�i������nn�n��
Taipever Nnme
Gomez, Mike A/Sharon H Werne
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State Parcel NumAer
26-12-09-300-004.103-027
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Ouner I First
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. . _ �g Address (number und sveeL ciry. smle, and ZIP code) � - —'- - � � —
p35O �OUTrF I g� Eii`�T
$ocial Sccurity Numbtt (last 5 diC�LS) Driver's Lice2e/Siale ID Numbrt (last 5 digiU)
Sra�K�,�
Addrcv (�umber and stree4 city, su�e. und'LIP cwie)
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Stturin• Number (laa 5 digirs) Drivcrs Licrnsc/SUtc ID Numbcr (1az� I
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Ilarvcv
Prinreton
006-04103-00 PT
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� �Same as pmpertr eddicci "�
i��r-roN, l� Y i
I�sse sp¢iF in Part 4 below)
I�E�N�
Sume :ti pmpeny addrts�
Othcr (plcasc spccify in Pan 4 bcbw)
9 2 10 7788 AC
Each undersigned certifies, under penalry o( pzpury�, that the abo�•e and foregoing infortnatiun is we and correct and that he or she is elieible to
recei�•e the homesiead siandard deduction on this property. Each undersi¢ned al>o understands tha� by claimine additional home;tead deductior
unlawfully, he or she may be liable for back taKes and substantial financial penalties. I
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