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i��, CLAIM FOR HOMESTEAD PROPERTY TAX F EAR
CREDIT/STANDARD DEDUCTION ° H
��� ��` Siate Fortn 5473 (R2l S92) .
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�� INSTRUCTIONS: See reverse side toi filing instructions. `� ��U
� CERTIPICATION STATEMENT - GIR
i(we)�c� e� ����?�--�—r �i h—�x'� �' a' e* L 4ertify that on the tst day ofMar �9s_
I(We) occupied as our cipal pia e of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
�(We) owned ❑ Are buying under contract �
Have a beneficial interest in Ihe entiry ihat is liable for the property taxes on the property and that owns the properry or is buying under a coniract.
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Rewrders office where cantract is recorded Record number . Page
PROPERTY DESCRIPTION
Counry Township mg disirict (city, wn, township)
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Parceinumber /� Legaldescripuon
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If any ponion of Ne resitleniial structure or �he land not exceeding one (1) acre ihat immediatey surrounds ihat sirucNre is usetl ro produce income, descnbe Ihe use and portion of
Ihe property utilized to produce inCOme. -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry , Township
Signature o imant �
l,ereby certify the above statements are true, correct and complete. /
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Atldress (number aiM street ciry, stale, ➢P code� ///�
/ a � P t' �.v 7�7
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately (��
surrounding resideniial improvements. '
Otherland (2)
Total land (line 7 plus line 2J (3)
Dwelling (4)
Residential improvemenis
Garege (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signature of Assesor Dace signed
complete.
Verityinq anion - Signature of Autlitor Date signed
STANDAflD DEDUCTION ALLOWANCE
19_ Pay 79 _.
Lesserof 1/2 Homestead S
Valuation or 52,000
SignaWre ot Auditor �/ ' Date signetl
+\ 1.2_k� �-� -ab
Gibson County Auditor
101 N Main
PRINCETON IN 47670
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IAFASUIlE0.fO0.V YIA
InJividuaLc an�i ma:�iN coupla are limi�ed io orc home�ead �andaN JNunion. As the wccipt of �hu dcduccion betomes
more beneficial, thrre is mwr incenme dun ner for homotead fraud Homaiead frwA nuses higM ta� bills for all: therefae.
HE.\ 13+3-?IX79 rcquim uxpa.en �ho reecive ihe homesreaJ sundard Jciluction w.eri(y �hat tAey sre :IieiMe to recene the
brnefi� ant to p�w'ide aktition�l identiiyine infurma�ion near.san� to allw' counp� gv.�emmenl ro Ynir monitrn IqmesttaJ
er��a. rn�: ��ra��„���� w�n n� �m �rdma,i anA on only h- accessnl by amMmN counry otTxiel; The Ixpanmrn� of
laral Gwenvnent finaM'< will mc this info�ma[ion W crca[e [c.�ls �Mt w'ill hdn mwm' offiials elimi�urc homeyeaJ fraud.
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Taxparer Name
Peylon, Charles O/ Rebecca L
Propertc Address
178? Concurd DR
PrincMOn IN,47670
Charfes O/ Rebecca L Pey[on
"o� r' n rd DR pZ �� , ��, n� �
� � b J� ������'-�"�" tate P rce NumDer Leeal Descrintion
Princeton IN 47670-9332 �/
II II III I III II II II II III II II Zs-»-�a-ioi-000.�as-oz� COLUMBIAVILLAGE,SEC27 0-�
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This form MUST be retumed to County Auditor's office. }
Please do NOT send this form back with your tax payment to the county t�easurer.