Homestead_Jones (7)�YS���1
e�/=' °� CLAIM FOR HOMESTEAD PROPERTY TAX
i��� CREDIT/STANDARD DEDUCTION
�;�� State Form 5473 (R2 / 5-92)
iei�
INSTRUCTIONS: See reverse side !or liling instructions.
FORM YEAR
HC70 ,�-
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Fz �. �. .
t��Ne) _���(,L�[ U�(_YJI.I� 1/(� certify that 1 1 �}'of M�pkt�1�3=
��) occupied as our principal place of residence the �following scribed real property for which a Homesiead Properry Tax 6r�i�it isTher2by claimed:
❑ I(We) owned ❑ Are buying under �contract . �
❑ Have a beneficial interest in the entiry thai is liable for the property taxes on the pmperty and ihat owns the property or is buying under a contraci.
. � CONTRACT RECORDED � — -
If buying on contrac[, Pee Simple owner's name - � � -
Recortler's oHice where mniraa is recortled Record number Page
Counry
PROPERTY DESCRIP'f10N
Township Taxirg distrip (dry. lOwn. township)
Parcel�number . LegaltlesCripiion
ooe=�l�a6=oo � ��5�-19-a=�o _ . g�w�
tl any portion of the resitlential strucwre or the IarM not ecceeding one (1 � acre ihat immediatey surrounds ihat siructure is used to produce inwme. descnbe ihe use and ponion
of the propeny ulilized to produce income.
TD. Y- 8-% ' - - .
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
Counry Township Couniy Tmvnsttip
�eby certify ihe above statements are true, correct and complete. Signa;eye o��
U
Address (numbe�andsveet ary, slate. ZlPwde)
'R j2 .'* 1
ASSESSOR USE ONLY
Land nof ezceeding 7(one) acre immediately
surrounding residential improvements.
Otherland
Total land (line 7 plus line 2�
Residential improvements
V"�
'��� TRUE TAR
VALUE
I1�)
I�Z)
Il3) ����
/`�3� ��
ASSESSED
VALUE
� �QO a
Q—
Other improvements ,/ �q � � �
� J� V
Total improvements (line 4 through lint I � lf 3� / � 0�
Total value (line 3 p�s line 7) � V I ��
I hereby cenify ihe above is true, correct, .
complete.
���dtying action - Signa;ure ot Auditor
19_Pay19_
Lesser of 1/2 HomestEr�,
Valuation or 52.000 ^r _ , , -
5
HOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE
signetl
Dare siqned
e
STAiEFOR\I5J569(0.1l&10) � iRE,lSURFRF00.NTS-IA
MPRO\'FD BY STAiE &iARD OF ACCOIJ�TS, 2009 PRESCRIBm BY T1fE DEPMTIE.\T OF LOGLL GOt'ER.\.V.E\T Fl�A.�CE IC61.1-??-8.1
Indi��iduals and married couples are limited to one homestead standard deduction. As the receipt of this
.�' �duction becomes more beneficial, there is more incentive than ever for homestead fraud. Hamestead fraud
causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers �rho receive the homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
information necessary to allow county governmeut to better monitor homestead filings. This� information
will be kept confidential and can only be accessed by authorized county officials. The Depart'ment of Local
Government Finance will use t6is information to create tools that will help couuty officials elimioate
homestead fraud. I
T�ivaverName -
Scott W/ Valerie D Jones
Complete and re(urn !n:
Onwl 1 ' 1
✓C�/ 1 I
Prooem Addrm
I58 E 200 S .
PRINCETON IN 47670
Stam Percel Number
26-12-19-200-001.926-027
G►BSON COUNTY AUDITOR, I01 N MAIN PR►NCETON IN 47670
(5g �. �o� 5,
Sodal Sewnry N�m�Ear (l+st 5 Eigib)
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Va�erie.
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o r�FS
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$otial Sennry MmDer �las[ 5 dlgln) Drivefs Lironse5taa ID NunEer (last 5 dipin) �11° �� (dease speciiy in+ an d Ceb.v)
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Each undersigned certifies, under penalty of perjury, that the above and foregoing infortnation is true and correct and that he or she is'eligible to receive t
homestead standard dedudion on this property. Each undersigned also understands that, by Gaiming additional homestead dedudions unlawfully, he or
she may be liable for back tazes and substantial financial penalties. '
Owfe� 1 Sip�atue Date
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