Homestead_Hartrt�� � CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
� f State Fwm 5473 (Ra / &00)
INSTRUCTIONS: See reverse side (or filing insWC6ons.
FORM � Y�'
HC10 �
I(V11e) � "v� "� certify that on the 1st day of MarT20_
I(VJe) ocwpied as ur prindpal place ot residence'the follow'vig described real property for which a Homestead Pro{��yLfaGC�ed���reby daimed:
�I(We) owned ❑ Are buying under contraq
1ave a benefiaal interest in the en6ty that is Iiabie for lhe property taxes on the property and Nat owns th property.or�s b g� under�a co�act.
If buying on conVact Fee Sunpie ownets name
o(
Tavnship
Legal tlesuiption
�%�'V/O�v � �
ot Ne residential sWCture w ihe land rrot exceeding
y uliiizetl to pro0uce income.
Record number
Tadng
w
Pape
(1) acre Ihat immediatey surrounds mat structure is used to produce inoome, describe ihe use and pwtim
20_Pay20_
Lesser of 12 Homestead
Valualion or 86,000
8
0
�
Gibson Counry Auditor
101 N Main
PRINCETON IN 47670
832
�vrxuauwRV�:n.
Individual> and invriN caupb are limiled �o one hnme�cad �amtaN Jnlu.uon. As ihe receipt oi �his dNuction 6econxs
mure beneficial, thcrc is more incentrce Uun r�er for homrstead fr�uJ. Ilomo�ead frauJ cau�es higM ta� bills for all: fiert(ore.
HE.\ I i�!-?IX!9 requires ta�papers aho wceire ihe hanesteaJ standa�d dnluction m.erily tfu� �hry am eli;iNe to rec.i.e the
6eneni an1 io pnxiJe aJAitimul idenniyinc inWrma�iun mre.sary ro allw� cwnn� garrnment ro Nner monitor IwmrsrcaJ
Olin�,�. Thi< infnrmalion will he Arp1 rtmlidcntiai anA e�an only he aare.xrl hy aulhorimi cnung nlFcial�. !he IXpanntcnl of
Lucal Gm'emmem Pi�unce will wc this inioimation W crcatt twls that will h:lp cvuntt olficials diminau humc>�ead traud.
��• �• � —
T•rioa�•er Name Prnpem� Address
Hart, Jodie ULisa M
Jodie L Hart
587 E Old Petersburg Rd
PRINCETON IN 47670-9512
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�ilin� Addrtss (Number and slree4 ��)'. s1a�e, and'LIP cude)
58 / O�ci �s �
cul Stturitr Numbn (las� 5 digita) DrivcYS LiccnulSta[c ID Ni
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State Parcel Number
26-05-32-100-001.833-027
V
R3 13or 19S A
Pnncemn IN 47670
Leeal Descrip�ion
006-01833-00 PT NW 32 1 10 4 AC
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(please speci( in I'an 4 below9
M�aai�
Na� �
� $ame u pmpeny address
(plcisc spccif� in Pazt 4 bclow)
idersigned certifies, under penalty of pepury, that the above and foregoing infortnation is we and correct and that he or she is elieible to
lhe homeslead s�andard deduc�ion on this property. Each undersigned al>o understands lhat, by claiming additional homestead deductions
illy, he or she may be liable for back ta.ees and substantial financial penalties. ��
`t'�/�o $�