Homestead_HolcombCLAIM FOR HOMESTEAD PROPERTY TAX
� " CREDIT/STANDARD DEDUCTION
t � Slate Form 5473 (R5 / 70-01)
°Y Presrribed by U�e Department of local GovemmeN Financa
INSTRUCTIONS: See reverse side lorfiling ins[ructions.
FORM YEAR
HC10
� � � � �
� M'e) l-�ti-LL/11�-GC1 0/' / / Ci�-�-�/ D/ (;4/.0 CC� certiry t on the �st day March. 20
I(We) occupied as our principal place of residence the foilowing described real property for which a Homestea roperty T�c redi � hereb ai d:
� 1(We) owned ❑ We buying under contract
GIB�QtJ COUNTV AUDITOR
�Have a benefidal interesl in the entiry thal is �iable for the property taxes on the property and that owns the property or is buying under a conVaIX.
If byrc�g m conVaG, Fee Simple ownets name
County
offica where conhact is recorded
'ry , Tamship
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�er e:
_ Q � s
n o/ the reaidenUai atruGUre w Me land not
ry uGTaee b Droduce income.
Twrnship
�� Ilsiha
one (1) aae ihet immediatary wrlounds lhat
I hereby certify the above statements are We, corred and complete.
ciry, afate,
Counry
Remrd numDer � Pa9e
Real Dropsrty ❑ Moblle Momo (I.C. bf. f-� .
is used to protluce (nmme, desaibe Cie use entl portlon
❑
Gibson County Auditor
101 N Main
PRINCETON IN 47670
1910
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INASUIIFAPoR4.l-1.�
IndividuuLc anJ ma;riN coupks are limimd to ore homcueaJ yanAanl Jnlu.�ion. As the reccip� of �his dedunion becomes �
merc beneficial, there is morc incentne dun r�er fur homn�eal fnud. Ilom�veaii faud causes hicM tn bilts fur all: iherefar.
HEA 13iA4f1119 requim uipi�en aho receive ihc hwnesicad standad Jnlunion io .erilv tlu� �hcy am eligiMc �o m�ene ihc
benefii aml io pnn�iJc a1Wi6onal iArntiiying infumia�ion nemvrc to allw' county ga'rmmml ro betrcr munitw homestt:d
tilin��. Thix in(ormminn will be Aryw mnfidrniinl anA r�n nnly h• aace:.nl hy authnriieA count�� nf7icials. Ihe Ikpanmem n(
Lucal Gm'vrmnem Pinam�c ��ill uw �Ais info�mation to crcam u+ds ihat x'ill hcip cpa�q' otTieiaL. eliminaL MmicstcaJ frauJ.
� � • � r � —
Taanaeer Namr Propertr AJd�=ess
Holcomb, Charies MNicky L
Charles M Holwmb
3951 W 75 S
PRINCETON IN 47670-8141
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State Parcel Number
26-11-16-200-004.162-027
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PRI�CI'f0� 1��47670 ^ h �
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Leoal Descript�ion
OOG04162-00 ROSE A;LINOA Lot 3 D-17
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ig Address (riumbcr undifictt, ciry, s[eic, and ZIP codcj -n� - n- � Same as propcm� a;dr�;— --
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in Pan 4
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ailin�: Addttss (Number and Nee4 �q', sWie, and ZII' codr) ��� 3+P�PrnY ��+Q+
3�i S l �J . 7 S S. Pr � � c�-fc•� �—�- -, � 4- 7� 7 U
Kial Securiry Number �lazt 5 digie;) Drivcr� LiccnselStaec ID Numbcr (1azt 5 digies) Othtt (plcssc spcciN in Part» bclow)
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dersigned certifies, under penalty of pepury•, that the above and foregoing infortna[iomis wz and coirect and that he or she is elieibiz to
the homeslead standard deduction on ihis propeny. Hach undersiened also understands that, by;claiming additional homestead deductions
dly, he or she may be liable for back taxes and substantial financial penalties. _� �'.
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y Datc
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