Homestead_MasonL• �� j
a�E R�3 YEAR
s��=^ ; CLAIM FOR HOMESTEAD PROPERTY TAX - ���° ` 1- FORM �
.�: CREDIT/STANDARD DEDUCTION i�UL" s � 93 HC�o �
,; �� Sute Form 5473 (R2 / 5�92) -
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INSTRUCTIONS: See reverse side 1or /iling instructians. . /� f1, .��S
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� ' "' �- � . � - CERTIFICATION STATEMENT - � �
I��We) . _- � U�6lN "' . certify thai on the 1st day of March, 19!�
�'e) occupied as our principal place.of residence the tollowing described reai property for which a Homesread Property Tax Credit is hereby daimed:
V I(We) owned ❑ Are buying under contract -.
❑ Have a beneficial interest in ihe entity ihat is liable for the property taxes on ihe property and that owns ihe property or is buying under a contract.
. . CONTRACTRECORDED : �� �-
If buying on contract, fee Simple owner's name . �
Recorder's oflice where contract is recorded ' Record number Paqe
town,
�7�'� Lv J°L Lv "
Parcel num6er Legal descnptio
�� - �i�9� �- �-� 4-a-io a. a� �-�.
Ii any ponion of ihe residen;ial strucmre or the land not ezceeding one (11 aue that immetliatety surrounds Nat strucNre is used to produce income, descrihe Ne use and portion
ot Ne properry utilizetl to protluce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
Couniy Township Counry Township
�—
eby certify the above statements are true, correct and complete. Signa� oi Caimam
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Adtlress (number and sfreeG ciry. state. ZIP aitle)
•R- i81� r-incefvn n� 76�0- G a-S
ASSESSOR USE ONLY . TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VAIUE VALUE VAIUE VALUE
Land not exceeding 7(one) acre immediately �
surrounding residential improvemenis. (�)
Other land (p)
7otal land (line 7 plus line Z� (3)
Dwelling (a) � �
Residential improvements
Garege (5�
Other improvemenis (6) . .
Total impmvements (line 4 through line � (7)
Total value Qine 3 p6s line � (g) �
I hereby certify ihe above is tme. Correct, and Signamre ot Assessor Date signed
complete.
nryrtg action - SignaWre of Auditor Date signetl
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ALLOWANCE
79_Pay19_ I
Lesser of 1/2 Homestead
Valuation or 52,000 5
SignaWreofAudltor _ �vl IDate
Gibson County Auditor
101 N Main
PRINCETON IN 47670
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APR 2 2 Z010
— �� ��
GIBSON COUNTY AUDITOR
3402
0
Dale A/ Susan K Mason
1645 E SR 64
Princeton IN 47670
i�At�
tlaiEfORAI!)W 1R'/w�l
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jiRtASUIIER Po0.N :StA
CMEI{.YNf]]TiNA\CE�CtrI.I- -tl
IndiviJuaL. anJ ma;riN couplc. are Iimi�nl io onc homcucad 3andaN J:tlu.iinn. As �hc �eceip� ol'this dcJuciion Mconrc�
merc brnenciaL �here i� morc incentke tlun ecer for honx+teacl fraud Ilomri�ead Baud causa hi�her m bi Is tor all; the�efore.
HEA liii-�009 requim uxpa.en who recei.�e ihe hanestcaJ sundarJ JNuction �o veriiy tMt �6ey are el eiNe �o recei.e tM1e
benefit aN �o p�m'idr addiional iJemiiyin_ infwmanun �xmxsary to allwr oounrc earmment ro bener muniror homeseael
filim�. Ihic infnrma�ion x�ill M Aryv rnnlidential anA can nnly fc arre..ed hy awhnr'unf row�tp nlTici�,Js.�Thr Uepanmem o(
I_oeal Gm<rtvnem Fifu�rce �cill u.c �his iniomution m i�rcam rwl� that w'i0 hdn cuain� offieiaL. dimiw c hnmeuead &aud.
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Taxoacer Namr
Mason, Dale A/ Susan K
State Parcel Number
26-12-09-300-001.597-027
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g Address (numbcr und strcct, city, smtc, and ZIP code)
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Sccurity Numbcr (last i dieiB) Driver's Liceme/Sule IU Number Qau 5 dieiu)
hliddle
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R2 13os 136 �
1'rincemn IN �7670
006-01597-00 PT SW I9 z 10 224 AC
� maso �
' — —� �Samc as pmpeM odd�i� — -
l� 4����-88zg
Odier (olease suecifv in Pan 4 below�)
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Address (t�umbcr md svttL ri�y, sulc, and "LIP code)
1 tc �-I S �, STr'�'r� 2� lo � �rcn ce �U �.
xuriq• Numhcr (lazt 5 dieiu) Drivcr's Liccrtu/5utc ID N�unbcr (last 5 digits) Ocher (pl
mAs�r
� Samr az praprny addres:
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undersiened certifies, under penalry o( perjury, that the above and fureboing inFortnatiun is we and cotrect and that he or sh'e is eligible to
:e the homes�ead standard deduction on this property. Each undersigned al>o understands that, by claimine additional homesiead deductions
rfully, he or she may be liable (or back taxes and substantial financial penalties.
�1 �{,mnt�ae Umc Telepfrone
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