Homestead_Heldt (5)n.
, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
Slate Form 5473 (R6 / 409j
Presaibed by the Department ot Local Govemment Finance
INSTRUCTIONS: See reverse side loi Iiling Insfmc(ions.
�FORM � 5 � EAR
�HC,o} ' j�
L
A�R 3 0 2004
� �e� �� ,Q / (/ /I, - - " G�ciOPl CJUi• i`v ,i �iv-=-t`�-Lr
���K ��� ��� certify that on Ne 1st day o� March, 20`_
I(We) occupied as our principa lace of residence the following described real property (or which a Homestead Property Tac Credit is hereby daimed:
❑ I(VJe) owned ❑ Me buying under contract
' Have a benefidal interest in Ihe entity that is liable for the property taxes on Ne property and that ovms the property or is buying under a conVaU.
I( buy'ug on conVaq. Fee Sfmple ownefs name
Recordefs ofica where conVact
Counry
Tamship
Par�— Q37a 3 ,�Legal de�,
I( any portian af Ne resiEenllal sWGUre a Me land not
of ihe property utiltrtd to produce inmme.
Toxnship
Ta�i^9
ona (1) atie ihal immediatey surtounds
I hereby certify Ne above statemenls are W e, corted and complete.
ci(y; sta(e, ZIP code)
�9,n 2 �
County
Rewrd number
Page
al properly ❑ Mobile Homo (I.C. 61.7-�
is useU to protluce inmme, desaiba Ne use and portion
Twvnship
�� �F� �-��°�`'`� � '"3"b`�� � TRUETAX� l+SSESSED�VALAJE �HOMESTEAD-'S � '� �NON SfOENTIAL '``+
r,"�v ', ASSESSOR�USE ONLY ti'_ x' b,1� � .__. � �� . �.,..> �' � '� #�'�.���
�� „�;y���.�x�„+„a„_,,,._ x VAI:UE� AT,�t00Ye:OF�TfV� �VALUE� �„;VALUE �k 4-
Land not exceeding 1(one) acre immediately (�� ��'������'��s,e �-ri
surrounding residential improvemenfs. ,s� '�a ,i's`
Other land �2� �`.�?�,v�.��.'i �-�
Tdal land (line 1 plus line 2) (g�
� s�;'x3«a P-":..�
Dwelling (4) �"'�-��` � �`� � � . �'
Residential improvemenLS or Mnualty '-'�'' -
Pssessed Mobile / Manttfach�rad Hortre Gara e ������ � 'k^���.'t�`��
9 (5) �i�a.�`.4��� -."�'KS_'�•Y. '. n�`�"�
Other impravements 6 ����,Y''`�� ����#
I ) :-��?F"'�s^�' ��
T�ial improvements (line 4 fhrough line 6) (��
TUaI value (line 3 pl's line n (g)
I hereby teAify fhe above is We, coved, and Sgnature otPSSessor Date signed
complete.
Vaitying aclion - SignaWre of Audibr Date sgnetl
20_Pay20_
Lesserof 1/2 Homestead
vewaUOn w E35.000 ,
Sgnatura of
$
Date
� '%—�.0 �
y4��f a ;;
/ (i 'J
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
1853
•lAR I(1RN �!Hlti/���1
iPG�S11�lRfOR4
InJiriJuals aod ma;rieJ toupks are limited to onc hmncucaJ aandaN U:tlunion. As �he raript ol ihi3 deduction becomc
more beneficial, thrrc is morc incrn[ne than e�cr (or humestead fnuJ. Ilumdtt:Kl fraud causes higher bi kills tur all: thercfore.
HEA 133i-?(H19 requim uxpapm who rceire Ihc hanesicaJ s�andarJ Jcduction m.�erily ihat they mc eliciMe m recei�e �he
benefit anJ tu pnn'idr aJJiiio�ul idtmifrin¢ inWmntmn nmessarv ro allw� counp� ga'nmmrnt �o be¢e� muniror humesteaJ
filin��. Ihis inlamutinn will 6e Ae�4 mnliJeaial anA nn nnh' he. acrec�eJ M1y amMrierJ rnunh' nfTcial�.'ITr Ikpannum nf
Local Gwcmmcnt FiN�rce aill ua this inionnainn m crcam `nds that �vill h-1n rnmre nff ak diminn� hnn�a�aA iraud
John M Heldt
621 S Country Lane
PRINCETON IN 47670-8135
I�I��II,��I�II��I���III���I��I����II��II��I�I���I�I,��II�II��I
Tasnaeer Name
Heldt, John M/Rita J
�
State Parcel NumAer
z�� i-� s-� oaoos.�zs-oz�
J
1�,�(,S
Princemn
6
I vhJ( �-�/ L�'� r
�� �
RO
Leeal Descripltion
YOUNG SUB DIV SUB LOT C D-17
I
,. ,
Ouner I • First MidNe LaSI
��� �.- �1/� fl2Tl � � �- � (
,
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g Adaiess �numecr ona sucet city, stnm. enuZlP cude)— -- -- -' ' � '�5ome u'proa�ry�aldn�"—' ' " - - - -' -
�-1 S, C p c1 ,.�'—iF-- �.I � i
Social Securih Numbcr (last 5 dieits) Driveis Licen, /Sute ID Nmnbcr Qau 5 digi�) Oiher (pleue speciF in Pan 4 below) (
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Spou;c First hlidJlc Last
� l T�r� �U N t ��- 0'�
Mailine .Add� (Numbrr and 9ree4 ��)', slale, and "LIP cude) Q$ame u pmpeny add�as
�� S. C�� r� ��- LN ,
Social Sauriry Numbtt (laz� 5 dicirs) Drivcrqti �Licqc,n��s�c/St�a[�c +I-D� Nwnpbcr Qa,� 5 dieits) Othcr (plcuc spccify in Part 4 bclow) �
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Fach undersiened certiftes, under penalry of perjury•, that the abo��e and foregoing in(urtnation is we and corrzc� and that he or she is elicible to
receive the homesiead siandard deduciion on this property. Each undersigned al;o undersiands that, by claimin¢ additional homesiead deductions
unlawfully, he or she may be liable for back taKes and substantial financial penal�ies.
U�ncr 1 newrc Un�c 'I'dephmc
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