Homestead_Hicksrt.
� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sla�e Fwm 5473 (RB / 4-03)
Prescnbed by (he Department ol Local Govemmenl Finance
INSTRUCTIONS: See reverse side Ioi liling insfmc(ians.
FORM
HC10
YEAR
"'f"�
I(We) certify that on the-:%t dpay o March�—� jj
b �
I(We) o pied ur principa� place oi residence lhe following described r al property for whith a Homestead PropertySme Credlt is! byl� "�
/
JCf I(VJe) owned ❑ P,re buying under contract A P R� 2 2004
� Have a benefidal interest in ihe entity that is liable for the property taxes on the properry and that owns the property or is buying un er a wntrect.
if buy'ug an contraC, Fee Simpie ownefs name
oifice where contraa is recoreed
County
Tamship
Legal desuiption
property in
Rewrd number � Page
..� vl0vv��0� �� I property ❑ Mobile Homo (I.C. &1.1-7)
If any porbon ot Ihe resitlentlal sW cture or the land not �ceeAing one (1) acre that immediatey wrrounds �hat swch�re is used la produce income, desttiba Ne use and portbn
ot the propeAy utilizeA b produce income.
County
I hereby certify the above statements are We, corred and complete.
�ddre /1 r mil . �^��Z�JL �'R / Y// i11�.
'
Land not exceeding 1(one) aae immediatety
surrounding residenfial improvemenLs.
Otherland
Total land (line 1 plus line 2)
Dwelling
Residential improvements orMnuaDy
Asse�ed Mobile / MenuF'actured Home Garage
Other improvements
Tatal improvements (line 4 lhrough line 6)
TUaI value (line 3 pl,s line �
I hereby certify the above is true, correU, and
complele.
Vrrify�g aaion - SigfaWre ofAutlimr
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(5)
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Signature ofAssessor
0
Date signed
�ate signed
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;� ac�,."-��:.��';-.z�-��`w��-.-p`STANDARU_DEDUCTION'ACCOWANCE4i'`-��>='"`° i'' � z�",��,�",a�`„�_�x+,3�'`�-`-'x`+
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20 _ Pay 20
Lesser ot 1/2 Homestead 5
Ydlua9on Of $35.0� �
SignaWraoflwditw " DatesigneC
ia '
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
3397
Jackie R/ Michelle L Hicks
1542 E SR64
Princeton IN 47670
Ounn 1
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�g Addrcss i
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Social
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g Addrcss (�umber nnd sYrttl cily, s�ate, und "LII' cale) � Same ai property add+as '
SS�aZ C s� /i �. �v f �iRr� .L•J 7(�70 {
Stturin� Numbcr (last 5 digiu) Drivcfs Liccnsc/Stare ID N�unbcr (la;t 5 digi�s) O�hcr (plcasc spccify in Pan ? bclox�)
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undersiened cznifies, under penalty of perjurp, that the abo��e and foregoing infortnatiun is we and correct and that he or she is elieible w
:e the homestead standard deduction on this propeny. Each undersiened also unders�ands that, by claimine additional home>tead deductions
✓fully, he or she may be liable for back taxes and substanrial financial penalties. �
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