HomeMy WebLinkAboutHomestead_McConnell (3)(� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� State Form 5473 (R6I403)
Presaibed by ihe Department of Local Govemment Financ_
INSTRUCTIONS: See ievcrsc side !or lilinq insfruclions.
1'� �
FORM
HC10
YEAR
��e) � certity that on tfie 1st day of Marcfi� 20
II 11 li I'.�.� (J —
I(We) occupied as our princip lace o( residence lhe followi scribed real property for which a Homestead'Property Tac Credit Is hereby daimed:
❑ I(We) owned ❑ Are buying under contract �' �� 1�/ �iJ �'
, Have a benefidal interest in lhe entity that is Iiable for ihe property taxes on lhe property and that owns lhe pro�ei�.or is buy`�g�i}der a wntract.
If byvig on conVad, Fee SimD�a ownefs name
Remrdefs oifice where
Counry
To.mship
G'9SG\ �'�.. .'` ,.i!_ -�-. .
Record numEer Page
Taring district (ciry, town, fownship)
�Lj}� ��` /^ I^U W I �89artl� -pu �.�Y/V I Is Ihe proVenY in question:
_ � � T ❑ Real property ❑ Mobile Homo (I C 67 1-�
H any porton ot Ne residenUal sWdure w �he lan not exceeding one (7 � aae ihat imrnetlialety �u� ds Nat sWCture is used lo produce income, tlesaibe Ne use and portion
or Ihe propery utilized m produce irimme. �/,, �`;
7
Gibson County Auditor
101 N Main
PRINCETON IN 47670
C�
SlilE fORU! 1!p �p� / uN�
'aqr.ucarnNnunin
InJiriJuals anJ inartiN coupk� are IimitN to nnc hnmcslcaJ s�andaN drduninn. Ay thz rtteipi oi this �deduaion beconres
merc beneficial. thrrc i. morc fncen[irr llun ncr (or hum�7ead fnud. Ilomn'tead (mud cau� hi�her Ias bills (or all; thercfwr.
HEA U43-?0119 requim uap�cen ��ho rcecive the hwnes�raJ nandard �rluction �o veri(y tha� �hey am eligiNe io mcei.e ihc
benefit an1 ro prm'iJe a�Wilion�l idenUirin_ iniorm�von nrmsin� iu allw� cwnn� emrmmeni ro beurr'munitw homeste:wf
lilir�y. Thi� inlnmu�ion xill M A�x mnlideniial and ran only M arcecrA by aWhorved counly nff¢i�Iti. (The Ikpanmrnl nf
Local Gwcmmem Fim'rc< �vill u�c this infurtna[ion tu arcatc t�vls �ha� will h:Ip eqmn� ofTxtials elimina7� Fpmesmad traud.
Taxpaeer Name
Page, Amy M
� I
133J Outcr lakc Rd
� �
Princeton IN 47670
3428
Amy M Page
1837 Outer Lake Rd
PRINCETON IN 47670
u
K Addrcss (numhcr end �mx�[, eiry, smic, and ZIP code)
� 3 D ��e r I�a
Smurity Yumbcr (last i digiLS) Ihiver's Licenae/$tale ID
� -��-
�.Address (Number and slree4 ��y. stale, and ZIP cl )
Sccurity Number (lasc 5 dieits) Drivds Lim2�dStatc ID Nmnbcr (last �.
_ ' �_
��
State Parcel Number Lesal Descriplion
26-12-09-302-002.172-027 006-02172-00 PT SW 9 210 .69 AC
�
P��mr� L
'ri r�ce f�✓
speci� in Part 4 below)
� $;une:u p(apeny add�a
lPlcisc specify in Pan 4 bclow)
e--
�ndersi{,med certifies, under penalry of perjury•. [hat the above and foregoing infortnation is truz and correct and that he or
e the homestead standard deduction on this propeny. Fach undenigned al>o undemands that, by claiming additional hom
fully, he or she may be liable for back taxes and substantial financial penalties.
� �pu� Umc 7'cl<phonc
i o�-�a �o �
Siptatu Uatc Tdcphonc
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elieible [o
I deductions