Homestead_Kolhouse (2);� � FORM YEAR
CLAIM FOR HOMESTEAD PROPERTY TAX �
CREDIT/STANDARD DEDUCTION HCio
State Form 5673 (R2 / 592)
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INSTRUCTIONS: See reverse side /o� liling inshuctions.
. _. °. � .: - : � ^ '•• .• � . � _ - . ." •CERTIFICATION STATEMENT-.: .... � � , .
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I(We) k P/ t f�i certity that on the 1st day of March, 19_
I(We) occupi as our principal place of residence the tollowing described reat property for which a Homestead Property Ta�`di�ereby claimed:
Y
.� I(We) owned ❑ Are buying under contract R�
Have a beneficial interest in the entiry ihat is liable for the property taxes on ihe property and thai owns t�'ro��er�y or4 u�ing under a contract.
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It buy'vy on contraa, Fee Simple owner's name
Recorder's oHice where comract is recordetl
Counry
� � c� — cf
tl any portion of
of the property i
: CONTRACT RECORDED : . . . : - �.
Page
) ' � � - � . - � PROPEHTY DESCRIPTION� - - ,. �-,- � -, a_.. _, ,.. -
� Township ��� Tauing di5tnd ( , fown, to�w�s�) '��
% r `I U �- (.cJ
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Legal description
��''l 1-ou
ie resqential s�ruclure or the land not exceetling one (1) acre that immediately wrrountls �hat structure is used ro produce income. describe [he use antl pomon
ilized to oraduce inmme.
�� ASSESSOR USE ONLY �, �, TflUE TAX ASSESSED HOMESTEAD ' NON-RESIDENitAL�:.. .'
. . �- � VALUE' VALUE VAWE � VALUE� � � �
Land not exceeding 1(one) acre immediately � . � -
surmunding residential improvements. (�) �
Otherland (Z) ' ° y -
:dd' :ra
•. >r
7otal land Qine 7 plus line 2� (3)
Dwelling (4) ' ` ° . , s , �-' .. � - ,
Residential improvements . . � �
Gara9e (5) � -.. -
Other improvements (6) -
7otal improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g) �
I hereby certify the above is irue, CorreCt, and Synature of Assessor Date signed
complele.
Verifying action - Sgnature of Autlitor Date sgned
.s
79_Pay19_
�ser of 1/2 Homesiead
�luation or $2,000
OEDUCTIOMALLOWANCE". _'.
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STAiE FOR.N 5)569 (Nl&10)
APPROI'FD BY STA7E BOARD OF ACCOU�TS, 2009
ITREASURERFOR.MTS�IA
PRESC0.IBFD BY i}IE DEPARTfE\T OF LOCAL G0�'F.R.\]�\T FI\A\CE iCb�l_I ��-9.1
Indi��iduals and married couples are limited to ooe homestead standard deduction. As the receipt of this
r�eduction becomes more beneficial, there is more incentive than ever for homestead fraud. H�imestead fraud
�
causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive th�e homestead
standard deductiou to verify that they are eligible to receive the benc6t and to provide additi�nal identif��ing
information necessary to allow county government to better monitor homestead Tilings. This information
�rill be kept confideutial and can only be accessed by authorized county officials. The Depart.ment of Local
Government Finauce �rill use this iuformation to create tools that will help county officials eliminate
homestead fraud. �
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Tunaven\ame pmoem'Addras SnteParcel\umber LeealDescrintion:
Lymnette R Kolhouse � 2 � z N I50 E 26-12-04-100-000.992-027 PT w Nw 4 2 10 6.503 AC
PRINCETON IN 47670 C.� i
Canip(ete and relurn !o: �����Q�DO������Q���m������' ���u������1���������
GIBSON COUNTY AUDITOR. 101 N MAIN PRINCETON IN A7670 �
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Pxtqr i . Fvst MitlEle � � ... �Last
�,Ynnti-F� � � Pua �'elhoas�— 5 k� I t�
Mailvp AOOress (nmEe� aritl sveet, qry, state an0 ZIP cotle) � �
'`� I Same es propany atltlreu �
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SodalSaurcilyNianCn�lazt5digih)
MiaEle ' . I Last
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L(�r �LG JlK���oi,
Madi�q PGtlrass (�mar aW strea� ury. sWte IP coCe) � Sartn as prope�ty aENess '
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Saaal
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Each undersigned certifies, under penalry of perjury, that the above and foregoing information is true and wrrect and that he or she is eligible to receive the
homestead standard deduction on this property. Each undersigned also understands that, by claiming additional homestead deductions unlawfully, he or
she may be liabie for back taxes and substantial financial penalties. � �
O+nx 1 Sig�anre Data Talaptqna �
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BSON COUNTYiAUDITOR