Homestead_Mizeur (3)ST�)F
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CLAIM FOR HOMESTEAD PROPERTY TAX -
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side /or �ling instructions.
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APR � 4 2001
CERTiFICATION STATEMENT �
I (VJe) certi hai@�� t� IT
I(We) occupied a r principal place of r idence the follovring described r ropeRy for which a Homestead Property Tax Credi�t is here6�tl�mea:
❑ I(We) owned ❑ Are buying under contract _
❑ Have a beneficial interest in ihe eniiry that is liable for the properry taxes on the property and that owns the properry or is buying under a coniract.
CONTRACT RECORDED
11 buyinq on conuact, Fee Simple ownefs name -
Recordefs office where contrect is recorded Recortl number Page
PROPERTY DESCRIPTION �
Counry� Township Tacing district (ciry. fown. rownship)
Parcel number Legal descnptio
- -OO � - D L
any portion ot ihe residential siructure or the land not exce aing one (1) acre that immediatey surtountls that structure is used to produce incortie, tlescnbe the use arid portion of
Ne properry uWized to protluce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township .
ign aimant �
.reby certify the above statements are W e, correct and complete.
dtlr ss(number and sfreel, ciry, stat . ZlPCOtle)
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ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 1(oneJ acre immediately (��
surtounding residential improvements.
Otherland (z)
Total land (line 7 plus line 2) (3)
Dwelling (4)
. Residential improvements
Garage (5)
Other improvemenis (6)
Total improvements Qine 4 Ihrough line 6) (7)
Total value (line 3 plus line 7J (8)
I hereby certify the above is true, correct, and Si9nature of Assesor Da[e signed
wmplete.
Veritying ac4on - Signature of Autlitor Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 79 _
Lesser of 1/2 Homestead $
Valuation or 52,000
SignaWre of Auditor ` Date signed
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� Gibs�%� n�County Auditor
101 N�Main
PRINCETON IN 47670
2163
InJiriJuaL+ anJ ma;rieJ muple are IimitcJ to orc hmneuenJ �tandaN A.f:dunion. As ihc rtteip� of ihi>� dnluctian becomeo
murc bcnencial, iherc is more incentirr tRm e�ar (or homesmxl fr.md. HomrsrcaJ fraud cauus hi�her ta� bdls for nIC [herefar.
HEA 13i:-10W requirn taipa�ers r�ho rcecire Ihc Munes�eeJ standvd dc�luction w vcrily Iha� thcy nrc c�ieiNe lo reteivr Ih.
brnefil anl to pmvide aWitio�ul idrntiirirc_� iniom�atwn mcr.san' lo allw' rounp� em'emment �o Y.urr moniror homese:rJ
filir��. This inlo�ma�im x�ill he Ae�v crntidcniial anA �n nnly M arce_�eJ h�� aWMrveJ rnump ofHaale The IkpannxT� o(
Local Gorcmmem Financc e�ill u.c �his information w arcmr twb �har �cill hdn cwnn� officfah <limi i< iwmcstcad frauJ.
Roger P/ Jane E Mizeur
817 N 275 E
PrincetonlN 47670-8920
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— �Owncr I First
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3�Addres;(r.unhcradsvcr:i^:�smt:�a�dZ'.o_od:)...— � —
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di�its) Other (plcue specify in Part 4 bdox�)
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inc .4ddreu (Number and sveel ciiy, staie, and "LIP axk)
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� $ame as propeny addrcss
�70
ase spccify in Part 4 bclow�)
h undersigned certifizs, under penxlty of perjup•, that the abo�•e and foregoine infortnation is we and correct and that he or slie is elieible to
�ive the homeslead standard deduction on this property. Each undersigned also understands that, by claimin¢ additional homestead deductions
iw�lly, he or she may bz liable for back taxes and substantial financial penal[ies. I
er I �ac UaL- 7'clephone /