Homestead_Rahman�, CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� S�a�e Form 5473 (R6 / 1-03)
Prescribed by ihe Departmenl of Local Govemment Finance
INSTRUCTIONS: See revcrsc side /oi lilinq fnslmr,ffons.
`('��� YEAR
� FORM �
HC10
�� i � � '�J
I(We) /`. certify Ihet on the 7st day of March, 20
i,
I(We) occupied as our principal pla t r idence lhe following described real property for which a Homestead Roperty 7ac Creditis hereby daimed:
❑ I(VJe) owned ❑ Are buying nder contract 1�1� `�`w%���'t� -�-�y'X
'' GISSOtd CUUNTV kU'uITC:: ,
` Have a benefidal in[erest in the entity �hat is liable (or ihe property taxes on the property and that owns the property or is buying under a conVact.
If buying on contraq, Fee Simple ownefs nama
Remrders olfica where contraC is recorded
County
Tvvnship
�U (� - C,� � ZS 4�-001 -�t 1 �
potlion of Oie residentlal sW cture w the Wntl not exteeding one (1 �
WoP�Y utilized to produte irroome.
Recard number
7�ing distric� (city,
Page
� �ihe property in question: � �
�L �eal Droperty ❑ Mobile Homo (/.C. 61.1-n
itiat immeEiatey surtounds that sWCture is used to produce income. describe Ne use antl portion
. �ff` ' {��'�`•��t"' '�'�'{ � �'`TRUE;TAXe �- ASSESSED�VALUE � HOMESTEAD�� tNON�2E�SI�ENTIAL°�'
�.A- ..� ,,, � �SgE.,,c�Ry�� LY . _ ^ ,¢,��'��VALUEg�?�`zs,��� � AT 100%OF'TN�y �?„t�VALUE� ��� '�.aW` �VALUE'&'` �� ��'
��` �,2:..�s o-.�'-,t'�3'
Land not exceeding 1(one) acre immediatety ���'�j° r�°` �'�^
surrounding residential improvemenis. (�� ��� � ��n�' �Y',
� n..:_ r
Other land � X � �
(2) ,{�.'� ; ��'..�
Total land (line 1 plus line 2) �3�
��ag�,�,�ix''c r�;�m�.,��
Dwelling (4) ���.�.�_�_. ,�c,-����.
e�T
Residential improvements or Mnuatly ���.,� ��r.
Assessed Moblie / Manufaciured Hane Garage (5) c-�� "y;'i{# ^ �� f:.a• �i
_.�-n,�s`� -.-�
Other improvements (6) '!:�.;��• �s����y���
7r:�a.-i, „
TUaI improvements (line 4lhrough line 6) (��
Tolal value (line 3 plts line n (8)
I hereby certify the above is We, carred, and Signature ofAsseswr Date sgned
complete.
Verilyinq action - Signature ofAuditor Date signed
20_Pay20_
Lesser of 1l2 Homestead
vauauon w E35.000
5
-'� J �i
•�
Gibson County Auditor
101 N. Main Street
Princeton, IN 47670
Sf�TE FORA15JSea(0.1/&I%
lAFASL'PFAiqLNRI��
Indiriduals and mamed cauplcs are limited to ane homcctead stsndard deduninn. As ;he. receipc of this daluctiw 6ecomes �
more beneficial, �here is morc incentivc �Iwi aer for homcsicad (aud. Homesirad Gaud ra�sscs higher tax bills for all; thcrcfore.
HEA 1311-?009 mquim tacpayTrs airo meei�x Ihe homestead�standard deducuan to �TTify eha[ �hef are eligi6le to rttens the
brnefit and to prmide addilional idrnlifi�ing infortnation necessary W allow counry gm'emrt�rnt ic�.better monitur homestead
filin�. This informaeion xill be kept conLdential and can only be attessed by authorized cou�ry ofTicials. 7fic Depazenen; of
Incal Gmxmment Fimnce will use tlds infortnatian ro cream mols that will heln counn' officia15 dimioate Iromestead fraud.
Taxpaver Name
Rahman, qifford W
� " . , � 693 S Persimmon Lane
PRINCETON jN 47670
1164
Clifford W Rahman� IIII�IuIIIW�III OIIuI ulll uIIII��III�I�II�IIu�IIOIIWII�I�II�II ul�� IuII uIIuII�I�I� II IIII
693 S Persimmon LN , �
PRINCETON IN 47670-8847 f
�"'I'lll�'�I��I"��'�"��"�I����I�I��I�'�'I��"���I"II���'�I" StateParcel Number Leaal Dzscription
� , 2612-16-200-002.184-027✓T NE NE TRACT 9:16 2�10 1 AC
_.. ; __. . . ._ _ . - y,�p
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� . � � �_ � � � 3J L ._. , . . _ _ .. .
, . APR 7 2011 - {
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This form MUST be re Nu� nerY o b�nty Auditor's office. � °
Please do NOT send this form b`���i w��i your tax payment to the coun,ty treasurer.
Addcess (number and strec4 ciry, stete, and ZIP code)
�
Samc az property addrcss
O[Iter (pleau specify in Pert 4�below)
�i.�li�n�
undersigned certifies, under penalty of perjury, that ihe above and foregoing information is vue and cortect
+e the homestead standard deducaon on this property. Each undersigned also understands that, by claiming a
�fully, he or she may be liable for back taxes and substanaal financial penalties. - �
�
`�%`��ll
�
or she is eligible to
�mestead deducrions
V