HomeMy WebLinkAboutHomestead_Holmes} CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� Sute Form 5673 (R6 / M3)
PrescriUed by Ihe Department d Local Govemment Finance
INSTRUCTIONS: See revcrsc side lor liling insfruclions-
�a�
FORM
HC10
YEAR
14 J.L :i.! : � i_d�
I(V✓e) � � �' certify thal on tha tst day of March, 20_
I(We) occupied as our 'n 'pal place of residence the fol 'n escribed real property for which a Homestead P�roperty_Tac G��t�js hereby daimed:
❑ I(We) owned ❑ Are buyirg under contrect //�� /
' Have a benefidal interesl in ihe entity ihat is liable (or ihe property taxes on the property and thal own5 ihe property�or is buN'ng under a� ntraU.
If buyin9 on conVact, Fee Simple ownefs name
Remrdels olfice whera conVac! is recarded
Couny � Tamship Tacing dist ct ^' ,
W
Parcel number l description Is ihe pro�
b-oo$ � 5� - z-
If any portion of the residentlal sWCNre or tha land not exceeding one (1) acre ihat immediatety sunounds Nat
W �he propery util'¢ed tn pr(idute iMOme.
� � � 3 �-t � s�
Record number � Page
Real property ❑ Mobile Homo (I.C. 67.7-n
ve is used tn pratluce income, desaibe the use and portion
� � �s���q"''�"T�'�."`'=�`°���� -� �'TRUETAX� ASSESSED�VAI..UE �HOMESTEADf`� `� �'�NON�ESIDENTL4L�.�{,.�
�a�-n���'•�.��. "SSi�'ESSOs,'£�`�-'U�ts�t,�'�'.,�%'�`sw�"a��s�.��a'�t�i.VALUE`i.r�.�.—AT,700%'OF+a.�TTV��,ii.?..VALUE.,Ca`?��'�°':�"..t.�:3�'1..VALUE.-�s�"-'v'�.a-^t'�_''
Land not exceeding 1(one) acre immediatety ���A" �� -�""C°`�` `'�� . ""
surrounding residentlal improvements. (�) ��+��.`.s�§"�F ��',,��y��
l.r ��'.� Y�'i�..,""+A±" ��TMTf�,`.
Otherland (2) m�� :;_;����
;�:..<, -.� �
Tdal land (line 1 plus line 2) (g)
t""4,� rz+a,� � �py"'.�
Dwelling (4) `�-' AG� ���M`� �.
Residentiel improvements orMnually ��'��"�'���"��
Assessed MobOe / Manufac�red Hane "��'�x:.. ; k���: �:
Garage (5) _ .`�"���''� .': "�'������
a�� - . �3'?s
Otherimprovemenls (6) �-J'.�."'�,�'_'•, �^_
Tatal improvements (line 4 through line 6) (7)
Tdal value (line 3 plrs line � (g�
I hereby cer�ify �he above is We, CorreC, and Signature of Assessor Date sgned
complete.
Vrrilying action - SignaW re of Auditor Date signed
20_Pay20_
Lesser of 1Yt Homestead
vauauon or 535.000
$
Date signed
__�
�'�.1 �j ., ir-i _
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
363 �
!OR\I!!k/Iti/)wl
1RFASURlR f00.4 .'..IA
IndividuaLS and marrinl coupks are Iimiied w nnc �omestcad �undaN dedunion. As �hc receip� ol thu dcdunion becanes
mure beneficial, there is marc incentnx than e�er for homrsteacl fnud Ilome�cyl laud ca�us highn u� bills (or all: therefae.
HEA 13ii-?d(W «qu'un �ayuyen w�ho rcccivc Ihc hanestced smndvd ANurtion �o .eNr iM they ve digiMe b mcei.e the
brnefit and to pnxidr ayfitioiul idenuirifrc informatiun necr�san to allw' cwnn' Ev:rmmrnt ro Nttct moniror homesttad
filin�. This information will h Aryw cwfi?mtinl anJ csn only h: aceczuJ hy authorized rouny� oR�ial+. The Ik7wMxm n(
Local Gmcmmrnt FinaM'< will u.c �hi5 in6rmation W cr�m 0.ula �ha� aill h:lp cpmb' ufficials climiiwh hwncstcad fiaud.
� � � � � � —
' Tasnacer Name Prnoert�� Address
Holmes, Comsby R/Mary J
s%/%` / /��/�/'/ 7`�,Q� � / 3i&5 N' 100 N
� �-/// r �S " —`� Princeton 1\ a7670
V
Cosby R Holmes
3585 W 100 N S[ate Parcel Number
PRINCETON IN 47670-8400
�i���������i��u�ni���ni�n�u�u���ni��n��u�n�i�nu��� 26-11'04-400.000.824-027
- V
Leoal Descriotion
006-00824-00 PT SE 4 2 11 5.9348 AC
D-1-13A-18 C-1
i -
This form MUST be returned to County Auditor's office. �
Please do NOT send this form back with your tax payment to the county treasurer.
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.Add� (numher mid stteec, cij4, smte, and ZIP cade)
ss5 � o AJ. t���c,; c
curip' umbcr (last 5 diei6) Drivcr's Li<cnx/Slate ID Nmnber (lasl 5 digiB)
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Address (NUmber and st ee4 city�, swie, xnd'LIP wik)
� SS`�S ttl •/ o ��/ Or ��/c e n.
tturiry� NumMr (lavi 5 digits) Dmrrs LiccnsNStatc ID Numbcr (last 5 digits)
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(pltast sptcif in Pan 4 below)
M�aai�
{�f o lrr� e <_
� Same as prapeny addres�
O�hcr (plcasc spccify in Pan 4
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Each undeni�med certifies, under penalty of perjury, that the above and foregoing infurtnution is We and correct and that he or she is elieible to
receive the homestead standard deduction on this propeny. Each undersi¢ned al>o unders�ands �hat, by claiming addiiional homestead deductions
unlawfully, he or she may be liable for back taKes and substantial financial penahies. �
Ownn 1 Si�uhue Uate 7'el<