Homestead_Memmer (3)�F e
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse sidelor filing instructions.
FORM
HC10
YEAR
C RTIFICATION STATEMENT
I(We) � certify that on ih 7 d of arch, �
I(4Ve) ied as our principal p e of residence the follo 'ng described real property for which a Homestead Property Tax redi
,'��j I�e) owned ❑ Are buying under contract SEP 2� L0�0
❑ Have a beneficial interest in the eniity that is Iiable for Ihe property taues on the property and that owns the properry or is ying under a contrac .
CONTRACTRECORDED
It buying on contract. Fee Simple ownels name DITOR I
Remrtlers office where contract is recorded . Recwd number Page
PROPERTY DESCRIPTION
County _ Tovmship Taring diSlriCl �ry to� , tav hipl -
arcel number (, Legal descnption
O v
any po n of o resi ential structure or the IaM rrot ezcecWing one (1) acre that immediatey sunounds that swcture is used m produce income, describe ihe use and portirn oE
the properry utilized ro produce income.
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township -
I
Si i re of cl imant
�iereby certify the above statements are true, correct and complete. `��.2���y��
Addr ss num rarMS(reet,ciry,state,ZlPmdeJ
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatety �� �
surrounding residential improvements.
Otherland ' �II�D N 2 9
Total land (line 7 p L� 3$Q(� .`U a(7D 1) .
Y
� -�%30a p — ��
. Residential improv �
' as�oc� ao� ''
Other improvemer.,,, . _ 6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, covect, and Signamre of Assewr Date signed
complete.
Verifyinq action - Signature of Autlibr Date signed
•_ STANDARD DEDUCTION ALLOWANCE
19_ Pay 79 _
Lesser of 7/2 Homestead �
S
Valuation or 52.000
SignaNre of Autlitw Date signetl
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
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508
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rarwtuvn wxv :su
PRF9[RIBFDBYIDf pEPARMEVi(1FLfItAIG(n£R'Jpll�T f1AAYCEMH.bL' �.I
Indn�iduaLc anJ marriN muplt� are limi�ed �o onc IromavrJ �andaN AeAunioa As �he recript oi �h� dMucuon become�
more beneficial. therc is more incentne than r�er tor homo'teaJ fraud Homeittal frzud caLL�es higM ta� 6ilis ia all; Iherciore.
HEA Gi�l-?009 rcquim taxpa�en who receive �hc hanesreaJ �undird dvluction m verify that �hcy art elicide to mcei.e ihe
benefil aN to p�m'ide additiowl idrntiiymc infortnation �xcesvn io ailw� counn� gm�emmrnt ro benrr monitw honx9e:¢I
filin�,�. This infnrmauon x'ill 6e Aryw ronlidentinl anA c�n nnly h accetuA hy autharized aoumr nfTicial:.'fhe Ikpannrcm of
Local Govemmrn� Pi`unce will me ehis iniortnation W crcat< rools �hat will h:lp avunq' otTicial> ciimiriam Irome>haJ fraud.
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Tazpacer Name Prooertc Address
Memmer, James D/ Loretta A
James D/ Loretta A Memmer
2199 N Carithers Rd
PrincetonlN 47670-8636
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g Addresc (numbcr m�d seat cny, smtc, end "GIY <oHe) - �� -- �
l99 �, C� ' �
��ocial $
pou:e First
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7ailing Address (NUmber nnJ >veet, rig', sWle, and "LIP code)
State Parcel Number
2Cr05-33-200-003.873-027
✓
R? 13ux 57
Princeton IN 47670
Leeal Description
006-03873-00 PT NW 33 7 10 1.40 AC
C-1
R1iddle
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. - _ � Smoe as p�operty u1d�c;s_ - . -' . '
P� to� �?'� �F767o
Other (p eace� spe f�Part 4 bdow)
� S:une u pmpmy addrcss
riro Number (lan 5 digits) Drivds Litta�c/SUre ID Numbcr (la,-t 5 digits) Oeher (pletic speciN in Pan �
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undersiened certifies, under penalry of perjury, that the abo��e and foregoing infortnation is we and correct and that he or she is elieible to
;e the homes�ead standard deduction on this propeny. Fach undersiened al;o undentands that, by claiming addiiional homest>ad deductions
��fully, he or she may be liable for back tares and substanrial financial penalties.
1 Si�menue
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