Homestead_McCoy (2)(��CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� Slate Fortn 5473 (R6 / 403)
Prescribed by the DepaNnenl of Local Govemment Finance
INSTRUCTIONS: See revcrse side lor liling inslmcGans.
FORM YEAR
HC10
� � �����`
property for which a Ho�rtle._stead FiopeityJT� Cred is � reby daimed:
�' G!�SGN C':�'dtt�,i Y Rl;�fir-- ,
(We) owned ❑ /ve buying under wniract .
❑ Have a benefidal interest in the entiry that is liable for the property taxes on Ihe property and that owns lhe property or is buying under a wntracl.
If buying on conVap, Fee Simple owners name
ReroNefs olfica where conVaq is remrdetl
Recard number � Page
Cwnry To.mship Tacing disUict (ciry, fown. hip)-�
Parcel num6er �.,.,l L al scription Is Ue property in uestion:
' '�J �eal property ❑ Mobile Homo (l.C. 6f.1-n
H any ponion of Ne residenUal sW chire w the land na e:ceeding one (1) acre that immediatey wrrounds Ihat swcture is used to produce income, describe Na use anC portbn
of the property utif¢ed m produce irroome.
i
CauNy
Twvnship
I hereby certi(y ihe above statements are We, corred and complete.
AdEreu (num6ereiMsVeet, city, s(ate, ZlPCOde)
Land nol exceeding 1(one) acre immediately
surrounding residential improvements.
Ofher land
Tdal land (line 1 plus line 2)
Owe�ling
Residentiel improvements or MnuaDy
Assessed Modle / Manufacfured Home Garage
Other improvements
Tdal improvemenis (line 4 fhrough line 6)
Tctal value (line 3 plus line n
I hereby certify the above is We, corted, and
complete.
Veritying action - SignaWre of Putliint
2�/�' ay20f�(
Lesser of 1/2 Homeste�
vauaoon w E35.000
NMitor
I�1
12)
(3)
(4)
(5)
(6)
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IBI
o(ASSessar
Couniy
S
Date signed
Date signed
Date signe0
Gibson County Auditor
101 N Main
PRINCETON IN 47670
•
1909
rbert L McCoy
773 S 350 W
PRINCETON IN 47670-8153
���i����n�i��ii�iii���iit�ii�in������
.urt roam!�!r. ��: N..�
n.rASUarxronrain -.
h�dividuab anJ mir�ieJ roupks arc limntd m nre homt�eaJ �andtN JrAu.tion. As �he rc[eipt of ihis 4edunion becomes
more beneficial, thrrc is morr incentn'e thm e�er (er humesrcad fnud. Ilomeaead fraud cauus hi�her �a� bill� tur all: thercfore.
HE.\ G7-i-70(!9 requim uxpa�en xho r.�ccivc Ihe hanrs�mJ smndvJ dnluction m.erify Ilut they are di•,iMr lo mc.ive Ih.
brnen� anJ to p�a'idr adlitiunal i�kmiryfm_ infumutwn Mcessary to alluu' counn� wnrmmrnt �o bener munitor homrs�eaJ
lilirp�.'lltic inlurmitinn will 6e Aryu cmfdtntinl and � n nnl�� M armseJ hy aulhorved tnunlr olLti:il>.'fhr Ik7+anment nf
I_ocal Govemmem Pinanc<will uw this iniormation W creatr [vix �hat �rfll h;lp nwnn� otTieiais elimiiuc Iromestead &aud.
• � � � � � —
T��paver Name ProoeT' Address
McCoy, Herbert L
/ State Parcel Number
26-11-16-200-004.144-027
�n�������i�ii� �
-�Owncr 1 First Afitltll
��Be�� Lp v..c S
e Addrev (numbcr nnd s¢cn, ciry. sm�c, and ZIY code) -- — ---' — -�—" —
. � 3 S 3s`z� �.
SoculSecuri�y Numba (las � digiLS) Urivers Licrnsd9ate ID Kumber Qazt 5 digiB) O�her (plrs
Addrev (I�umbcr and �trc<t ciiy, swie, and ZII' cak)
5 digits) � Drivcrs Liccnu/5utc ID ��unbcr (last 5
R2
PRI\CITO\ 1� 47670
Leeal Description
SANDSTONE PLACE l0T 5
e�iow,
� $ume as propeny ad +ues;
5peciN in Part 3 bclow)
undersiened certifies, under penalty of �pury•, that the abo�•r and (ure�oing infortnation is we and correct and that he or sh° is elicible to
;e the homesiead standard deduction on this property. Each undersi¢ned al;o understands that, by claimine additional homestead deductions
.�fully, he or she may be lixble for back taxes and substantial financial penalties.
I Si�nae Uetc 1'
c �