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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fartn 5473 (R2 / S92) �
FORM
HC10
YEAR
INSTRUCTIONS: See reverse side for (ling inshuctions. Fp
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� C TI CATION STATEMENT�� �`� �� !� �;'j kl
I(We) . �� + cert (�[ on the 1 st day of March, 19_
I(We) occup' as 'ncipal place of residence t e following described real pmperty for which e F�lome�ead/� t+rty Tax Credii is hereby claimed:
❑ 1 (VJe) owned ❑ Are buying under coniract � ' � � � ,, : C:� /J /
❑ Have a beneficial interest in the enGty that is liable for the property taxes on the pmperty andlhat oivns the:property oj-iib�ing under a contract.
u.�5�n ::. '; y .,UDITCR
CONTRACTRECORDED
Ii buyi�g an conVacf, Fee Simple owner's name -
Recorders otfwe where contract is recorded � RecorC number Page
� PROPERTY DESCRIPTION
Cou Tovmship Taxing distn (, to , f ship
Parcelnumber _ ���� Legaldescn �on � � / ` �
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If arry ponion of the residential structure or the larid froi exceedirg one (1) acr ihat immediatety surtounds thai svucture is usetl to protluce income, tlescribe the use and ponion of
ihe pmperty utilized to praduce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Couniy Township
S natu f daimant „
,ereby certify the above statements are We, correct and complete. /�
I Addr u r dsireet �N.state,��e) ^ L ���0
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ASSESSOR USE ONLY . �U TAX , ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (� �
surrounding residential improvemenis.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4) �
Residential improvements
Garage (5)
Other improvements (6)
Total improvements Qine 4 through line 6) (7)
Totai value (line 3 plus line 7) (8)
1 hereby certify the above is tme, cortect, and Signature of Assesor Date signed
wmplete.
Venfying action - Signature ot Auditor Date signetl
�' STANDAflD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead y
aluation or 52,000
Si of Autli Date signed
a-�i-a��c
�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
h�diviJuals and irtu�iN coupk� arc limimd to one hmneueaJ �randaN Jnlunion. As Ne receip� of �hi; dcducuon bccoma
more beneficial, tlrrc is morc fncenene than r�<r for honx'tea�l flawi Hommeml f`aud o� higher tan 6ills tor all: Ihenfore.
HEA 13L1-71N19 reqvim mcpa�en �ho recei.e iM1c hanes�cad sta�da�J �kvluction in veri(v ilut �M1ey me clicide to meei.e tM1c
bznefit ani to pnw'idr additio�ul iJentifrin_ iniomu�nun nece.'vey to aliw' county ernemmrnl ro bertef moniror IromesteaJ
tilin��.'fliis inlmrtu�ion xill M Aryw ccuJi�icmial anA nn nNy b�: accciuvl by authorizN counry� n(ficial:.'@e Ikrynnirn� nf
local Gm�cmmrnt Finmrce will u.e �his iniortnation W areate 4vis �hm o'ill help trountt otTcials diminnrc hom<sicad fnud.
827
Jeffrey C/ Gina A Kendle
1797 N Old Petersburg Rd
Princeton IN 47670-8509
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er I First
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4g AUGiess lnumlier mni succt cirv. su[e. nu ZIP eudj j'"
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al Securil} Numba (last 5 die�LS) Driva's Licen�e/Statt
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rirv Number (last 5 di�its) DrivcYS Liccnsc/Sl1ic ID Numbcr (la.t 5
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�oid Pet-Q�R�rs
31 1 10 5.00
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ut sptcify in Part 4 below)
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�Same as pmpeny adJ+o� �
OTn in _�J. `i /� �Q
undersiened cenifies, undzr penalty of perjury•, that the abovz and (oregoing informatiun is we and correct and that he or
�e the homes�ead siandard deduction on this propeny. 6ach undersicned al;o understands tha� by claimine additional hott
�fully, he or she may be liable for back taxes and substantial financial penal[ies.
I Signaiwc \ . � � / �l Uate � Telephone �
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