Homestead_Miller (9)CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
Siate Form 5473 (R6 / M3)
Presrribed by the Department of Local Govemment Finance
MSTRUCTIONS: See reverse side /oi filing inslmc(ions.
���
FORM
HC10
YEAR
� M�e) .,��-�/L/L/ y/ ���1G� / certify lhat on the 7st CBy.�ilN�r�.89�T
I(We) occupied as our principal place of reSidence ihe following descnbed real property for which a Homestead Property T Credi� is hereby imed:
❑ I(We) owned ❑ Fve buying under contract
� Have a benefidal interest in the entlry that is liable for the property laxes on �he pwperty and that owns the pro0erty iy�pp . qgl�pJl
If buy'u�g om m�trap, Fee Simple owners name
Recorders olfice whera coniract is remrded
County
Tavnship
Record number � Page
Narcel n/µm Der Leg npti Is ihe prope�r�ry /in question: '
��Q � ���—�� � � /�' �'�� bp Raal property ❑ MobNa Homo (/.C. 67.1-�
�
N any portion of the residential sWqure w the land not ezceeEing one (1) aae that immeCiately surrounds that sWGure is used to produce income, describe Ue use antl ponion
of Ne property uWized tn produce income.
/� �o?0 9�9c
��?-`�F � A E OR� SE ONLY�.�.- =�� � i��TRUE TAX�� � ASSESSEU VALUE �+HOMESTEAD� �T` � O iiES��ENTIAI Y:-�
� `.7�#�8-e's ��.T�_'�_ �_'3��.res:x� �'�iVAI:UE�ies.�-,�` dA»i700%OFRTTVrs 5:�.�_`--V/1LUE� �`-��"s}�. �.VALUEnu:��.t�
Land not exceeding 1(one) acre immediatety � 7.`�,"����"'� �"� a. -- �
surtoundingresidentialimprovemenls. (�� ��"���j���i.�z=•. '��.
�
Other land � -�'�"� "' ��� �
(�) �a;..���'".�
Tdal land (line 1 plus line 2) (g� �
^u-+G_„�,�..,�.��`���!Fi '�`�'-"�
Dwelling (4) �����.`-r�,-t�',�w � �fr ' . �
Residentiel improvemenLS orMnualty , .
0.ssessed Mobile / ManufacWred Hmre Garage (5) �a� . r�'., s�,� .���,�' �'
�n. � '�at�;n� .x..f. �n.=u-
��`z;��. --r��'
Otherimprovements (6) -, _�,�'Q�r;�
:: '�.. �1�.
Tdal improvements (line 4 through line 6) (7�
Tdal value (line 3 plus line n (g�
I hereby ceRi(y U�e above is We, coned, and Signature of Assessor Date signed
complete.
VaifyNg acl'an - SignaWre ollwditor Date sgned
�r��,�'°�„yL �,'�:�T?�� �?��3��s.�`=�STAN DAR�'DEDUCTION'AL' LOWANCEYt� ��.',�'� �.tj„�„ro;i�.�"d,�r'�"�.`.°�ii�t'��F,'..�+`7',��'���'r �
20_Pay20_
Lesser of 1/2 Homestead
vauauon « E35.000 g
SgnaWre oi Niddw " Date sgned
Gibson County Audilor
101 N Main
PRINCETON IN 47670
�\FIL,�I�
_ OCT 2 1 �uw
GIBSON,C �N� A�aITGFt
554
R�i£ i00.]I J!.'M IIL' / YMI
f00.N�1�
lndividuaL+ and inxriN coupkc are IimitN io onc homcucaJ �xandard drduaion. As the receipi ol' �his dcduction bttoms
marc bcneficial, tMe is morc incrntn< �han ner tor M1omesteacl fraud. Ilonx�eaJ frwJ caus� hi�her ta� bilis lur all; thereforr.
HHA 1333-?IX19 requim uxparen .rho receive �he Iromes�cad smndarJ dedunion io rerity that they are <IlciNe �o recci�c �he
benefii an1 ro p`w�idr at4iitioml idemiirin_ informatiun necr.'vrv ro allox� counn� gm'emmem ro beircr muniror homesrcaJ
filim�.. This infnrmaiion xill be kqw emtidrniial and can nNy h: aaresseJ M1r w�Mmcv1 coumy oRciais. `I'he Ikpanmem of
Lacal Gm'crrvnem fiwnc< will u.< this intorma;ion ro i�rcatr tools iha� �vill hcln tamcr ofTidals elimina�e krtncstcad kaud.
T•rspacer Name
Miller, Steve M .
8� I S 350'
Princemn I\ �
Steve M Miller �
841 S 350 W . State Parcel Number Leaal Descrint
PRINCETON IN 47670-8154
26-11-16-200-000.067-027 006-0oo67-OO PT E NE
LI��IL��I�II„I�„IIL�J��I���JIJ�LJ�J�L�L�JL�IIJ ,� o-»
.'._� _. "_--T'_' " " - r.��: _ __�_..�—____ _' ..� '_' '
This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the county tr�
0
Addtess (number end s�eet, ciry, s[e�e, nnd ZIP cade)
.4ddress (Number and iVm4 cily, slaie, and'LIP code)
1i�
as pmpeny addlcv
(plcssc specif in Pan 4 belox�)
� Same as plopem addrea�
(plcise spccify in Patt 4 below�)
2 ii is.zoenc
r.
undersigned certifirs, undzr penalry of peryuty, that the aboce anti forcgoing infonnation is we and coirect and that he or she�is elieible to
;e the homestead standard deduciion on this property. Fach undersi¢ned al;o understands that, by claiming additional homest lad deductions
Jfully, he or she may be liable for back taxes and substantial financial penalties.
1 Signature � , ^ �l Uam 7'elephonc
�
� �