Homestead_Kelley,�� "" - CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
�• �� � State Fortn 5473 (R2 / S92)
�'i�C.c�7f,
INSTRUCTIONS: See reverse side /or (ling inshuctions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT ' �� ' �' ��
�1' a .��t��,
I(We) "t'�rtiry'thafon the 1st ��of March, 19_
I(We) occupied as our principal plac residence the following descri e real property for which a HomesteadOH�e�a�A�ii is hereby claimed:
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❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property tazes on the property and ihat � the prope( or � uying - der contract.
✓
CONTRACT RECORDED �J '�=����'�` �` `��" "'�"' "" � � �
It buying on contracc, Fee Simple ownefs name
Fiecortlefs office where contracl is recorOed Recortl number , Page
PROPERTY DESCRIPTION
Counry Township Taning tl¢trict (ciry, rown, township)
Parcelnumber Legaltlescripdon �
- �-�o - a- � i 1��3�3 � �
f any portion of Ne resitlential struaure or the land not exceeCinq one (7) acre that immeaiately surtourWs ihat swcture is used to pmduce income, describe ihe use and portion of
the pro0erty utilizetl to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County Township County Township
Si tu� of mant .
�ereby certify the above statements are true, conect and complete.
ACtlress (num6er antl street. ury, sta7e, ZIP ooOeJ - '
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding t(one) acre immediately (��
surrounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvements .
Garage (5)
Oiher improvements (6)
Totai improvements (line 4 through line 6J (7)
Total value (line 3 p/us line 7) (8)
I hereby certify the above is true, correct, and Signamre o( hssemr Date signed I
wmplete.
Verifying ac6on - Signature of Audiror Date signetl I
� STANDARD DEDUCTION ALLOWANCE
79_ Pay 19 _
Lesser of 1/2 Homestead c�
� Valuation or 52,000
SgnaNre of Autlitw D�signed I
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Gibson County Auditor �' � , , , ' � , ,�
901 N fSlain '
PRINCETON IN 47670 InJividuaL anJ marriN mupks are limi�ed �o ore homeaeaJ wandaN �l^duaion. A� �he rccctip� 01 ih(i Jeduc�ion becomes
morc beneficial, therc i� morc incenmr dun e�er for M1omateacl Gaud. Ilomnrcal Baud cauxs hieher ta� bilk (or aIC thercfae.
� HEA I}a-i-?IHl9 rrquim uip�ren who recci.r Ihe hanenead sundard �vlunion m verify tfui �hey ore �eligiNe io recenr ihe
brnefit aM ro prm�id< aiktitio�ul idrnutyin_ informniun nemsary to allw� counn' �ro+rmmrni ro Nnir rzwnrtw IwmesttaJ
filirqi+.'Ihis in(orrtu�ion xill he l.ryu conliJeNinl and enn nnly h: accecud Fy aWhorieeA rounp' n�Lcials. "fAe Ikpann�� of
I.ucal Gwemment Rfu�rce will uu �his inimmation m aream muls that will hdn cnunn� ufl'iciaL. dimii�nc hxnacad fiaud
0
1348
Timothy M Kelley
2565 W 100 N
Princeton IN 47670-8565
I�I��II���I�II��I���III���I��I��I�I��II���I�I��II���I�I����III
Taxpaver \ame
� Kelley, Timothy M
� R.i 6or 2a �
Princemn 1\ 47670
State Parcel Number Leeal Descri�ition
26-11-03-400-002.211-027 006-02211-OOPTSE 3211 1.3a3AC
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Ou'ner 1 First Middle La51
; �o+tiy M,���R � KELLFy I
�g Aadress (numUeTm�a �ticet, city. smee, endZlY ttdel -- —' —� -- —'— -� ume+u prop..m' uL.'ucu ' —
a � (v .5 'v✓ �OD /1� ���,�1GE�o�/ .Z�c/ �7G70 I
Social Securily Numbrr (last 5 digits) Uriver's License/$Ute ID Nmnber (lasl 5 di:its) Other (plcuc sptcifv in Part 4 below) �
�- .
Spouu First Middlc ��
"sl"o � "� ���h l�� LC�� �
Mailine AJdre55 (Number anJ riree4 cil}', slale, und ZIP Cak) �f$ame vti pmperty addteis (
� S lo� 1�.'. � 00 /J. 'NC��u�J nt .`fZCn?c� u
Social Stturin� Number (last 5 digirs) Drivcrs Liccnsc/Statc ID N�unbcr (I -� 5 digits) Oihcr (plcasc spccify in Part = bclow') I
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Fach undersicned wrtifies, under penalry of �rjup•, that the abovz and foregoing infonnation is we and coireci and that he or she is elieible to
receive the homestead standard deduction on this property. 6ach undersiened al>o understands that, by claiming addilional homzs�ead deductions
unlau�fully, he or she may be liable for back taxes and substantial financial penalties. I�
O..Ter I Signanac Uatc Tdcphonc �
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