Homestead_MontgomeryCLAIM FOR HOAAESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
SIaU Form 5473 (R6I403) .
Reaaibe0 M Me Deparhnerrt of Locel Gowmrt�en[ Finanoe
MSTRUCTiONS: See ie`eras aW brfF�p iq6uM'oro.
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re prope r which a es a �GI¢bk is��eD�ipaimed:
❑ 1(We) owned ❑ Ne buyirg under wntract �
' Have a benefidal interest in the enti thal is liable for the ro e taxes on the ro e
tY p p rty p p rty and that owns the property or is buying under a wnVacl.
If buying on conVacl, Fee Simpia ownefs name
County
H any ponion of
ofthe praperyi
County
where conVacl is remrdeA
descripGon
Tating
Is the
Rewrd number � Page
��p �� I �eal Droperty ❑ Mobile Homo (I.C. 61.7-n
sWCWre or the Wnd not exceeding one (1) aae that immeEiatety wrrounds Nat hucWre is used to produce income. Ces�iibe Me uu and portion
ice inmme.
Tpvnship
Coun�y
I hereby certify the above statements are We, correct and complete. I�
@dd_ess umber aM �5(reet, ci(}; stafe, ZIP code) _ _ � � '
������`'`�'fM1�j"'—"���� "4' �"TRUETAX�'� ASBESSEDVALUE '�HOMESTEADK NONiiESIDENTIAL�� n
{-�s-� �tA�S.S���SE ONL_�Y'z - , _ VALUEy,�'�� �''AT�700%.OF�'T7V� ���VALUE��' �£��VAI:UEF b .x=:
-��P� _ ?� Y� � �_..... � zi. " snzt�.;�....,. .. �'w �`��E."'��
Land not exceeding 1(one) acre immedialey �:,9.�5'� t3t �,F �''�t�:p`�� �r��
surrounding residential improvemenls. (� � ��"'��."�t{`' ��'tY� z'�`,5�. �,��_�
Otherland {{�"���";���'"�"ry "
(2) � ,:..
�t.?sw�..'���
Tdal land (line 1 plus line 2) (g)
) .� �r= 3'yz ��,'�,.-..��,'�'�3
Dwelling (4 ��,���a� � 4 w�.���
Residendal improvemenffi or MnuaOy
Aase�ed MobOe / Manufac�Wred Haro �> A-sr�` -,
Garage �5� ��,�a.�:..:;'�'- #�cl'�`.��'s��.��
��.M�.�s
Other improvements (6) �ye' `.<r ' �
�..s�"��:
Talal improvemenis Qine 4 fhrough line 6) (�)
TUaI value (line 3 phs line n (g)
I hereby certify ihe above is We, corred, and Signature of Assessor Date signed
complete. ,
Vrrifying action - Signature of Auditor Date signed
20 _ Pay 20 _
Lesser W 1/2 Homestead
va�em�, «sss.000
E
I Date si�2� � �
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T -a- � zr-� �r--�
rrnrerov,MVSwN�s�T
'IF}ASL'RFA400.NRIA
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Gibson County Auditor � � � / � � � � � � � �
, 101 N. Main Street .. i„di��d�ai: and married couples are limired to one homestead ztandud deduaioa As the receipt o� this deductiun becomes
. Princeton, IN 47670 morc brn<ficial, Uitrc is more incrntive Itun ner for Iwmcstead fmud. Homatead Gaud rruses higher �aa bills for all; there(ort.
F I L E�. H� ,3�.�� �w� ��P�� a�, ��,.� �� homcstead stmdard deductian to �xrify that chey ire eligible to rceei�e Ihc
� brnefil and �o pro�ide additimul idenuf�ing infmmnlion necessary to ellw� county gmcmmecl �o liener manitor homM^*A
filin �y'. 71us informatioo uill be kept ronfidential and can only be atcessed by au�horiud counry aff.�cials. Thc Departmrnt of
. � Local Govemmrn: Finxnce will use this infortnation m crta[e tools that will help count�� ofFrmls elim�IUte homestead frzud
APR°1 S 2011 � —
_ C.'J.n�.y .
� — GIBSON COUN Y1AU ITOR
3526 - -
Jason K Montgomery
2993 E Curtice W
o PRINCETON IN 47670.8870.
I�I���I�II�II�'I�I�I����I�I��I'll�'I'�I�'I'��'�I�'���I��I��II��iI
3
Taxpaver Name Location Address .
Montgomery, Jason K/Lisa M .
� CURTICE L�ANE �
PRINCETON IM 47670
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II01�111��III �II�I �III nll I� IIIIDI�II�IIQ�II�II�II�III011011 �I�II �I
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State Parcel Number Leaal D
26-12-15-100-004.184-02 �PT NE SE NW 15 21
This form MUST be returned to County Auditor's o�ce.
Please do NOT send this form back with your tax payment to the cou
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�e the homenead standard deduction on this properry. Each undersigried also understands that, by claiming additional homestead deducrions
�fully, 6e or she may be liable for back taxes and substantial fmancial penalties. j
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