HomeMy WebLinkAboutHomestead_Gordon (3)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
t Sieta Fortn 5473 (R6 / 4-03)
Plesufbed by Ne Department of Loral Govemment Finance
INSTRUCTIONS: See reverse side !or (ling insfiictions.
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FORM I YEAR _
HC10
FIL,EI�
n . ' _.. _ _ �.'=;a'�33`a��"��� : -. .
I(We) ''- "certify lhat on the 1st day o( March, 20
I(We) occupied as our principal place of residence lhe lowing described real property for which a Homestead Tac is hereby Gaimed:
❑ I(We) owned ❑ We buying under contract - � �
QIBSON COUN� Ay91fi9f�
� Have a benefidal interest in Ne entity Nat is liable for fhe properry taxes on the property and that owns ihe property or is buying under a conVact.
If buy'ug on cpnirad, Fee Simple ownefs name
Remrtlefs ofice where conVacl is
County � .
f
Toxnship
district
Rewrd number � Page
I number Le al Ee C n �
I ,^ ^�,^ 9 yn`',� Is the property in queslion:
L� �'S'.�/� �UU{. � �J�11�" �5�� I D � Real Dr Derry ❑ Mob'le Ho o(l C 6f 7-7)
ponion af Ne residential sWCWre or tbe 7��nm exceeding one (1) aae ihat immediatety sunounds Nat swcture is used to produce income, describe the use and ponion
properry uWized to produce income.� .
y aSQ�
County
Tavnship
I hereby ceAify the above statements are W e, covect and wmplele.
and streef, city, sta(e,
'��"��z-��.� �'�'"�`�Y� '�'+ R �+-.�'''TRUETNC � � ASSESSEDVALUE � HOMESTEAD`Y�, NON RESIDENTIAL�'� �
4- S sA5SES50R'�USEONLY.�-- � � �� '*L 'Y'f
��-�`�-�.4..�a�.3-�� �,:d,..i:�s„ ;Y.,.<`-r � � ��VALl1E:��, �r AT 100%'OFtTN�.. �eVALUE�'�.� ���. z � VALUE^�,_,;".?��
- ' ...,.u� s�35, ...�..-�
Land not exceeding 7.(one) aae immediately 3k ,� �, �i�+t ��
surrounding residential improvementa (�) ���' " �#� i�,�„�,�_?
Other land ��� ,.-�� �
(z) �rn�'�
K,._
:.�-� " =
TUaI land (line 1 pfus line 2) (3)
ajR�2� ��� F ���.�
}� � �
Dwelling �<) 2.'�,,;:tirr�«.t'�'..:�r -'-'-:.��
�Residential improvements orAnnually '��^�� � "��b�^ ^�'
Pssessed Mobile / ManuFactured Hane Garege �5) �. ���K �`�'3��
,� �� t,'-��__
Other im rovemenis ��� "� �s `
P (6) �`.�_����
3..:#.i a�-
Total improvemenis (line 4 through line 6) (�)
T�tal value (line 3 phs line n (6)
I hereby certify the above is We, corred, and SignaWre of Asseswr Data signetl
mmplete.
Verilying aclion - Synature of PLtlitor Date signeE
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�'�. �� �-.�-�^'N,�i3r����v,�`�`�"`a�`�`���`STANDARU:DEDUCTION'ALLOWANCE � �' '�r` ' -`.y" "�'� -� rt '
. '�,�'..�: u`f. ��s,s��`a� -�s�+�'v3w=s`'���?�: t
20 _ Pay 20 _
Lesser of V2 Homestead
vauauon or E35.000 S
Sgnatureotlwditw � Datesigned
SIAiEFORN!!K�ICfnuO � 1RFASLAQPo2431�`
.���N(TE11PT�l11EG11RIl(IIMYY.yP'�c_!Vn �Af_AWIImpTIIICUE�A0.1MEYffIFIIXALCATCLVMlI.'LiTA\fEll'bll-E'�l.I
Gibson County Auditor
101NMain '�' • � � 1 '•�' • � •
PRINCETON IN 47670 InJiviJual.+ anJ marriN coupin are IfmitN �o nnc homeucad aanJaN JNunion. A> ihe rarip� of �hi; dadoninn becomcs
more beneficiai, thcre is morc incrn:nx �han r�er (or honx�teaci fraW. Iiomo�eacl fauJ cau.ses higher tac 6ills for all: themfare.
• HEA Iii3-?fN19 requircs uxpa.m .rho recei.�e �hc hanesteaJ standard dnfuctian �o .erify dwt �hcy art eliciNc to mcene ihc
brnefi� am1 iu p�rn'iJ< a�YJitional iJemiiyin� inWmiarun Mcessarr to allw� cuunn� gv.�rmmmi ro N_[rcf munnor Iwmese:N
filin��_ Ihis infmmaiion xill M Aryv mntiJcNial and can nnly M aarc:�cd Fy wthom<d rnunp' o(ficiali'Ihr Ucpanmm� n(
I.ueal Gmartvn<at Fi�uirce will me thi� iniomution ro erea:r uuls that will hdn camrv otT "al. dimivm Mmenead fiaud.
1376
William Gordon
908 N 500 W
PRINCETON IN 47676-8409
���ii��in�i��ii�u����iii�u����ii����n���n��n��ii�i������
ner 1 First
�lL�iq ov
,� naa� �d�meR �d �umi, ciry, stare, anti �iP codcj— —
1ogN 50o W I'rincefon � '
aial5ecurit} Number (last 5 dieits) Drivtrs LicensdS�ate ID Nmnber (la,t 5 digits)
Addrtss (t�umber and axree4 nl)', statc, and ZfP code)
Stturiry Numbcr (Iazt 5 digits)
Trspacer Neme
Gordon, William
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Prnpertc Address
R3 Bor I69 /� 't��
' ^ V
Nrincctonl\i�7670 `� �
State Parcel Number Leeal Descr
26-11-OS-40¢000.774-027 PT SE 5 2 71 .78
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Othcr (pleaze spa
Drivtt's' LiccnsdStam ID Nwnbcr (lai� 5 digits) � O[hcr (picuc
m�p�oyer. utdm::--
ran 4
� Same u proyeny addrtss
D-1-18
undersiened certifies, under penalty of perjury•, that the abovz xnd foregoing information is we and correct and that he or she is eligibk to
�e the homestead siandard deduclion on this property. Each undersicned al>o understands that, by claimine additional home;tead deductions
fully, he or she may be liable for back taxes and substantial financial penalties. I
1 $i6naturc � Dalc
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