Homestead_MayerY� rt�n � CLAIM FOR HOMESTEAD PROPERTY TAX
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� CREDIT/STANDARD DEDUCTION
.�` e State Form 5473 (R2 / S92)
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INSTRUCTIONS: See reverse side /or liling instruIXions.
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I (We) certify
I(We) upied as our principal pl of residence the follovring described real prope for which a Homestead
�� I(We) owned ❑ Are buying under contract
Have a beneficial interest in the entity ihat is liable for the property taxes on the property and that owns the�
FORM YEAR
HC10
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Ihat o�n�71ihp�; 1 �y��{�.�������ch, 79
Propert�'i'�7c �edh i571Nt2by Gaimed:
- .. i , : �� - . . � � 'r'-... , .. .. CONTRACT RECORDED,-. � :-,: y:�.%. ... '. f .,,�c� �., _,,�,, _ . :
It buying am m�iraa, Fee Simple owner's name �
Recorder's ottice where Contran is reCOrtletl Record number Page
PROPERTY
Cou Tawnship
Parcel umDer ��O � Legal des pti n /
r
If any ponion of �he residential stmcture or the land not exceetling one (7 � acre
of ihe properry uGlized to produce inmme.
. ._ ...'__ 'v.':, ' '�_'- � �.
��a-/� � 7'0�� C
surrounds that structure is used ro produce income, describe the use and portion
�ASSESSOR USE ONLY `�� � TRUE 7AX � ASSESSED HOMESTEAD�. � . � � � NON-RESIDENTIAL`s `. ,
- , � � VALUE VALUE VALUE - - ' VALUE �
Land not exceeding 7(one) acre immediatety �� � �� �
surrounding residential improvements. (�) � �"�
Otherland (p) °���� � �
s a:-C
Total land (line 1 p/us line 2� (3)
Dwelling (a) ^ • ,. � � F .
Residential impmvemenis -
Garage (5) . ... ..
Other improvements (6) � � �
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g�
I hereby certity Ihe above is true, correct 0nd Sgnamre of Assessor Da�e signed
complete.
Venfying aaion - Signature of Audiror Date sgned
,o
19_Pay19_
Lesser of 1/2 Homestead
Valuation or $2,000
S
zt
Datesig ��
STATE FOR.N 53569 (RlB-10) iREASURER FORA1 TS-IA
APPROVFD BY S�ATE BOARD OF ACCOII�TS, :009 PRFSCRIBED BY THE DEPMiN�T OF LOCAL GOVER.�'�tE�T FI�ANCE IC6�1.1-22-8.1
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
��aduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
�eauses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive thc homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additional identif��ing
information oecessary to allow county government to better monitor homestead filings. This information
will be kept con5dential and can only be accessed by authorized county oftcials. The Department of Local
Governmeut Finance will use this informatiou to create tools that will help county officials eliminate
homestead fraud.
Teioarrr \ame
William 1/ Kelli R Mayer
Complete and return !a:
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949
Prooem Address - �
949 S DOGWOOD LN/
PRRJCETON IN-07670
SMte Percel \umber
26-12-IS-200-003.980-027
I°�lI���C��;��f
GIBSON COUNTY AUDITOR, ]Ol N b7A1N PRINCETON IN 47670
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Same as noperty eatlreu
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Drrvars Licensal5ta:e ID NunOar paat 5 tlipitn� �e �'� (Wesse speaty af Pan a Oebw)
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EaCh untlersignetl certfies, untler penalty of perjury, thai the above antl toregofng fntomtation is true antl GoRect antl that ne or she �s eligible to recerve �
homestead standard dedudion on this property. Each undersigned atso understands that, by claiming additional homesread deductior�s unlawfully, he or
she may be liable for back taxes and substantiai financial penalties.
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GIBSON COUNTY