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E °, CLAIM FOR HOMESTEAD PROPERTY TAX
i;��'� CREDIT/STANDARD DEDUCTION
,�,;�� State Form 5473 (R2 / 5�92)
INSTRUCTIONS: See reverse side lor tiling instructions.
FORM
HC10
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I(W �(/� �(�C� �J .�/ //"V — certify thai on the 7st day of March, 79
I(We cupie as our pr ci al place resitlence the following described real property for which a Homestead Prope re it is r by�ial' ed:
j{We) owned Are buying under coniract �� �� �� �
J H a v e a b e n e t i ci a l i n t e re s t i n t h e e n t i ry t h a t i s l i a b l e f o r t h e p r o p e rt y t a x e s o n t h e p ro p e rt y a n d i h a t o w n s t h e p r o p e rt y o r i s b u i n g� u n d e r c o n t r a c i.
, �� I. 1 1�QG
PROPERTY OWNED BY CLAIMANT�IN OTHER COUNTIES
� certiry the above statemenis are true, correct and complete.
(numbei and s1reeC city, sfale. ZlP code)
ASSESSOR USE ONLY
Land noi exceeding t(one) acre immediately
surrounding residential improvements.
Otherland
Total land (line 7 plus line Z�
Dwelling
Residential improvements
Garege
Other improvemenis
Total improvements (line 4 fhrough lina �
Total value (line 3 p�s line 7)
I hereby certify the above is true, correct, and
complete.
19_Pay19_
Lesser of tl2 Homestead
Valuation or 52,000
TRUE TAX
VALUE
(�)
(Z)
(3)
(4)
(5)
(6)
(�)
i81
Signature ofASSessor
SignaNre of claimant
ASSESSED I HOMESTEAD
VALUE VALUE
STANDARD DEDUCTION
S
NON-RESIDENTtAL
VALUE
Date signed
Date signed
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464
Gibson County Auditor
101 N. Main SVeel
Princeton,IN 47670
SGTE fORM SIkN (0.1/610)
TRIASL"PE0.f➢0.NlS1A
Indi�iduals and married muplrs are limited to one homesiead standard deductioo. As the receipt of this deJuctiw bewma
more brneficial, �hem is morc incentivc than a�er for Iwmcstcad fnud Homamad freud rauses highcr ux hills for all; therefort,
HFA 13M-?009 requi�es uxpa}crs w�ho rccenc �hc hom<stcad srandard dcdunion to �ttiF� iha� c6ey are eligiblc ro recei.z tfrc
brncfii nnd lo p`miM additimul idcntif��ng informaiion nccessary b allow' cwnry gm�.mmrnt e> bencr monitm homestead
o filings�'11tis infortnacion wiil bc kept confidrnrial and can onty M accesud by eutharizcd wunrv cifiicials.'Ihc Dcpartrnrnt of
. I,ocal Gwemmm[ Finanm will use tt�is information to crtam tuols that will helu counrv officials.elimi�te homestead�freud.
Larry G/ Lorri K Rembe
701 S White Church RD
. Pnnceton IN 47670-8122 .
I�I��Ill��li��l�l��r��i�llilllilili�l�l�
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Taxpayer Name
Rembe, Larry GJ Lorri K
X
011 �I �III �II I�
Location Address
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701 S WHITE C[,iURCH RD �
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PRINCETON IN 47670
II� II I 01101� 111 �II �I �IIQ II�I QI� II Illl
�I�'Ii,.l.iy'''yI�I..II I I'll ' State Parcel Number Leaal Dzscription
.�� ��_ 26 1-15-101-001.711-027�%�dDY RIDGE EST�SEC A 17
APR 2 8 .2011 �
o . c.�.M� ,
This form MU��ii�°��iu�ne�io County Auditor's office. '
Please do NOT send this form back with your tax payment to the county treasurer.
LA2Qy G E� �
� Mailing Addiess (numbcr end succt, ciry, stau, md Z[P codc) —�
701 S. I,c.)Nrrs�ccRLy l�at-� ° f'Q,
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undersigned certifies, under penalty of perjury, that the above and foregoing infortnation is We and correct and tha[ he or she is eligible to
;e the homestead standard deducrion on this property. Each undersigned also understands that, by claiming additional liomestead deducdon
�fu0y, he or she may_be liable for back [axes and substantial financial penalties. - . '
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