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a"`5i„`°- CLAIM FOR HOMESTEAD PROPERTY TAX
4 CREDIT/STANDARD DEDUCTION
:• �� State Fortn 5473 (R2 / 592)
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INSTRUCTIONS: See reverse side lor filing instructions.
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- CERTIFICATION STATEMENT
I(We) '�` certify that o e 7 st day o March, 19_
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I(We) occupied as our principal place o residence the tollowing described real property for which a� omestead_Ffope ax Cr is reby Gaimed:
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❑ 1(We) owned ❑ Are buying under contract ' GIBSOtd �,:_,!; f: �,� pUDITOR �
❑ Have a beneficial interest in the entity that is liable for the propeAy taxes on the property and thai owns the pmperty or is buying under a contrad.
� CONTRACTRECORDED
It buying on conVact. Fee Simple owners name
Recortlefs office where convact is recorded � Record number Page
PROPERTY DESCRIPTION
Counry Township T�ing di5tric ci - to , t i
Parcel number Legal descnpUon
- � G� JD %- �-�D �-
If any ponion of ihe residential stnxxure or the land noi exceetlirg one (1) acre that immediatety surtounds ihat swcture is used to produce irkome, describe the use and portion of
Ne property utilized ro produce income. �
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry TownSNp
r ' e o imant
ereby certify the above statements are true, correct and complete.
Atltlress (numbe� and stree(, ciry. sfafe. ZIP cotle) '
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ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VAIUE VALUE VALUE
Land not exceeding 1(one) acre immediately �� �
surrounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2) - '(3)
Dwelling (4) -
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 fhrough line 6) (7)
Total value (line 3 plus line 7J (8)
I hereby certify the above is true, correct, and Signamre of Assewr Da�e signed
complete.+
Verifying action - Signature of Auditor Date signetl
�• STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead �
Valuation or 52,000
Si ofAudor Datesig� — � _��
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
249
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�nwvmuau ana ma:neu couplcc arc limnea m ore �nme�e�J �anJaN ANunion. ns ihe recerpt oi this�JNunian 6ecomes
more beneficial, therc is morc incmtne Oun ecer (ar humes�esl frdud Ilomasrcad faud causes higher tac 6ills lur all: ihere(we.
HEA li4i-20M requves uxpaun v:ho recei.e ihc hqnesteeJ standard dnluction w.erity Iha� ehey are elitiNe lo recei.e the
benefi� and ro p�m'ide additioml idenuirma in(orm�uon neces'vry ro aliw' counry� grnrmment ro Y.ver mmimr Mmestt:d
fili��. This inforrtution x�ili 6r {.q+ canfide�uial anA ean onl�� M arrecud br awhoriuJ cowtr mTiaial_. �The Ikpannxm nf
Lucal Gw<rmmem Pinante ��ill ua this intomiation tu crcatt ttvle Ihat �rill h:in camn' offiriaLs dfmivic hnme.��aA (nud.
Karia L Moore
&3-8ex�73 B
Patoka IN 476669210
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Taxpaver Name
Moore, Karla L
State Parcel NumAer
26-05-40.107-003.884-02
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PatoAa IN -0
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7 006-03884-00 PT U
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This form MUST be retumed to County Auditor's office.
Piease do NOT send this form back with your tax payment to the county
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g Address (numbcr and �vmc, ciry, smtc, and ZIP code)
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Address (Number and stree4 d�)', state, and "LII' cuJe)
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Same ns propem addttss
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fv in Part 4 btlox�)
� Same us pmpem addre�s
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Each undersigned certifies, under penalty of pequry, that the abo��e and (oregoin�_ infurtnation is we and colrzct and that he or she. is elieible to
receive the homes�ead standard deduction on this property. Each undersicned al;o understands that, by claiming additional homestiad deductions
unlau�fully, he or she may be liable for back tases and substantial £mancial penalties. I
Ox'oa 1$irTznae Ihte
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