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.'�CLAIM FOR HOMESTEAD PROPERTY TAX FORM
� �� CREDIT/STANDARD DEDUCTION HC�o
SWte Form 5473 (R2 / 5�92)
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INSTRUCTIONS: See reverse side /or 7iling instructions.
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,� (We) ��J Il.t.cXN N � �� certiry thai oM4�.1 �2y d�kh, 19_
�Ve) xcupied as our principal place of residence the following described real property for which a Homesiead P rty Tax Cre�it i ereby im
LJ I(We) owned ❑ Are buyin9 under contract �����
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❑ Have a beneficial interesi in ihe entiry that is liable for the property taxes on the property and Ihai owns th �ro�f�iis buying �u`nder a conhact.
II Euyirg on contraa, Fee Simple owner's name
Recorder's ottice where contract is recorded
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Counry Township
Legal
If any portion of the residential swdura or Ihe land not
af the property utiized to produce income.
Record number � Page
- : -PROPERTY�DESCRIPTION , . ° . ;;.� ,?,�,-ia�. ..,a;:.. ,- - - -
Tazing distriq (city, town. rownship) �
L ,uw ��-a �sa-�v 3.6��t
one (7)�thai immediatey surtounds that structure is used to produce i�ome, descnbe the use arW ponion
- . . ^ •. - ' . '-.':.PROPERTY OWNED BY�CLAIMANT INATHER COUNTIES'.. � _ .
Counry Township Counry Township
;reby cenity ihe above siatements are true, correct and complete. S n re o( im ,t
n s(nu ee srree�, dry, state, v ) � �/'
V
eo " '� °�"��� " ' TRUE�TAX 'ASSESSED HOMESTEAD ` � NON-RESIDENTIAL'.;`�
"ASSESSOR USE ONLY ` _ � �, VACUE" � � , � ' VACUE,� � VALUE � � VAWE � •'
.. .�. ._ _ _, _ .. �_.. . . .. .. ..... ._. ., ,
Land not exceeding 7(one) acre immediarely � _�-�
surrounding residential improvements. (�) � " } n
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Other land (p� � ."ff � '�'z'- �'- �
�-�, g�°b�r� � c .
Total land (line 7 plus line Z� (3� .
- A, . . 4� ' . ., � � ,
Dwelling (4) ^.�9� �.
Residential improvements � '�- -
Garage (g) . , � . .
Other improvements (6) � , � `
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g)
I hereby Certify the above is IrUe, correci, and Signature of Assessor Date signed
complete.
�ntying action - Signature of Auditor Date syned
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^ • SUiEfORM�JW�1l/f-rvl 1RFASU�ERPoRV�SIA
Gibson Counry Auditor
101 N Main
PRINCETON IN 47670
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APR 1 2 ZU10
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— GIBSON COUNTY AUDITOR
1322
InJrviduaL and marricd rouplcs arc Iimi�N w one hom�teaJ wndaN Jcdu.uon. As �he receip� nf this dMuaion becaue;
more beneficial, thrre is morc incentne tlun e�er for homo'rcad fqucl. Ilomo�e�l fraud causa higher tas bills (or all; themfore.
HEA 13i1-?O(19 requirty iacpa�cn who r.ceire ihe hanesmaJ smndard hvlunion to .erity tlut ihey arc eligiNc to reaene ihe
benefii am1 m prw�ide akliiional iJrntii�'inc fnWrmatiun Mces>arr ro allw� vounrc em'rmmmt ro bens moniror homesteaf
tilin��. Iliis inlomviion x�ill he AryV mntiJrnli�l anA c�n nnly tk: arm:.ed M1v authorized rounq oBciu(s. 7he Depannxnt of
Local Goremmcm fim�rc< �vill ux this intormazion W crcate ta�ls ihat will h:lp camn' uffieials dimi.wm IromeACad fiaud.
Trxoa��er Name
Parke, Ronald G/Susan G
Prooem� Address
R2 Ibx ?65 (\\�
V
Princcton II: i7670
Ronald G Parke
587 S Curtice W Sta�e Parcel Number LeQal Description
PRINCETON IN 47670-8863 —
I I II I II I III I I I I II II I I I I II I z�'iz-�5-zoo-ooi.eoo-o2� oos-oiaoo-ooPrenwrR.acrz iszio
�u �u� nin niniun �ni iuiin� u / 3.689ACC-1
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This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
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Oana I First Middle Lut
RONA lc� � • �ArK�
g Addr¢s (numbcr end sace[, city, stfltc, and ZI P c c) � Semc ns pmErem nddmss
J`�g7 5. �'ur�'�ce LN ��� NCeto.� =N �-17(o7J '
$ocial Sccurity Numbcr (last 3 diC�LS) Ihivers LicrnsdState ID Number (last 5 digiB) Other (plmse specify in Pan 4 below)
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Spouse Firs[ �1 Middle n L�st
5:� S A�1 ls • F'A r k2
Mailin¢ Addrtss (Number anJ eyrcc4 riiy, sw�e, and ZIP cnak) � S:une:u pmpeny address '
58l 5• C4r�{-i'ce L�l 4���%ce-h��.+ S� LI7L?O
Social Security Number (lazc 5 digits) Drivers Liccnsc/Sutc ID Nwnbe: Qa,� 5 dieits) O�M1cr (pleue spcciN in Pan 4 bclow)
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Each undesiened certifies, undzr penalry of perjury•, that the above and fureeoing infortnation is true and cortect and that he or she is eli4ible to
receive the homestead standard deduction on this property. Each undersiened also understands that, by claiming additional homestead deductions
unlawfully, he or she may be liable for back taxes and substannal financial pennities.
Owncr I - tur� � ' %1� �y - 4 - � 0 7'cicphone �� / � ) �
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Spouse ��namre � � �to Telephone
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