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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
INATRI/CTIONAr Sa.e reVPr.cP s(de /o!I%I%nnlnsfmcflnns.
FORM YEAR
HC10�, , •� ' �
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� W i v � �00�
CERTIFICATION STATEMENT ^
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I(We) cenify that atrWe_isTd�y y arch�
I,�(W^e) occupied as our principal place of r sidence the following descnbed real property for which a Homestead Property TaSc Credit is liereby�cla' �,rcr�
�e) owned ❑ Are buying under contract
ave a beneficial iNerest in the entiry that is liable for the property taxes-on the pmperty and that owns the property or is buying under a contract.
CONTRACTRECORDED � �
If buying on contract, Fee Simple ownefs name �
Rewrdefs omce where contraci is recorded Record number Pa9e
PROPERTY DESCRIPTION �
Counry Township Ta�ci tlistrict (ciry, wn, township)
Parcel numrber p, Legal description
l�' 1 � ^�
tl any portion ot Ihe residential s(rutlure or Ne IarM nat exceedi� one (1) acre that immediatey surtounds Nat sUUC[ure is used to produce income, describe the use and portion of
ihe properry uWized to protluce income.
PROPERTY OWNED BY CLAIMANT IN OTHER�COUNTRIES
Counry Township County Tovmship
Si nature of daimant
�ereby certify the above statements are true, correct and complete. 5��� � �,,,,�—
AdAress (numbe� and street, ciry. slafe, ZIP code) ' I
J�t3 1(;o.r �oSH � /leeian SN y7�70
ASSESSOR USE ONLY TRUE TAX _ ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(oneJ acre immediately (� �
sunounding residential improvemenis.
Oiher land (2)
Total land (line 7 plus line 2) (3) �
Dwelling (4)
Residential improvements
Garage (5)
Oiher improvements (6)
Total improvements (line 4 through line 6J (7)
Total value (line 3 plus line 7J (8)
I hereby certi(y the above is true, conect, and Signawre of Assesor Da�e si9ned
complete.
Verifying action - Signature of Auditor Date signed
. STANDARD DEDUCTION ALLOWANCE
79_ Pay 19 _ -
Lesser of 1/2 Homestead S
Valuation or S2,000
Signature of Auditor � Date siqned
53569�R1IB-10) � I TAEASUNER FOR.\ITS-IA
�SiATE BOARD OF ACCOU�?5, :OD9 PRESCRIBED BY T}IE DFPART�.\T OF LOCAL fA\'ER.�'1ff:1.T FI\A\CE ICbl.l �?-b.l
Individuals and married couples are limited to one homestead standard deductioo. As the rFCeipt of this
r eduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers �r•ho receive the� homestead
standard deduction to verify that they are eligible to receive the benefit and to proride additional identifying
information necessary to allow county govemment to better monitor homestead filings. This �information
will be kept confidential and can only be accessed by authorized county officials. The Departiuent of Local
Covernment Finance will use this informatioo to create tools that will help county ofecials eliminate
homestead fraud. �
Taxoarer M1ame
Susan Hunt
Comp(e!e and relurn !o:
Prooerfv.�ddrest Stah Parcel �umber Leeal Descrinlion�
1205 N I50 EAST/CARRHERS ROAD Z6-12•OS•200-003.992-027 PT NE 5 2 10 II391 AC
PRR.CETON M 57670 �_ � �
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
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SLISa�- �
MaiWp MEreu (nmber aM aVeel, tiy, ua:e aM
la OS .>v / $O F
Sotial $enairy N�anber pas� 5 tlipib)
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sine ONer (Glease spxJy i
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MiOCIe
nsarne es orwem maeu
sn. � Ou+er IWease soeah in aan a oaiowl
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Each undersigned certifies, under penalty of perjury, that the above and foregoinq information is true and wrrect and that he or she is eligible to receive the
homesiead standard dedudion on this property. Each undersigned also understands that, by claiming additional homestead deductions� unlawfully, he or
she may be liable tor back tazes and substantial financial penalties. �
Oanmt Sip�alire Date Teleptme
�_.. �..w�- j �- 9�/ 2 (
Spousa Sipeutve Date Telepta're I
� �
NOV 9 2012
c.�.�-,
GIBSON