Homestead_RetterAn•n CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR i
'�"' � CREDIT/STANDARD DEDUCTION �o
'� f Sfate Fortn 5473 (R5/ 10-01)
�°� Presrnbed by the Departmenl of Local Govemment Finanre - �
INSTRUCTIONS: See reverse side for filing instroc�ions.
STATEMENT
I(We) hYl v/(Xt Y.CJ � �`�Gl-�-f/OCX- ��'.C.lfl� certify
I(We)9ccupied as our principa� place o( residence the foliowing described real pmperty for which a Homestead�
r�Ub i 2U�2
(VJe) owned ❑ Are buying under wniract
lave a benefidal interest in the entity ihat is liable for the property taxes on Ihe properry and that owns the property or is buying under a coniract.
-t"rr_.-.a.�-,3st... 'r�';= � •"-: . ,�,?� .' CONTRACT'RECORDED .., - i`'°�.-. . .
II huying on cantraq. Fee Simplo owners name
Remrdefs olfice where contrad is recorded Record number Page
Caunty
%.a
Tavnship
_ _ ..�i• .,.
Parcel number Legal description Is the D�operty in question: � -�
�� � — Q(J q ! � _ � � � % 6' 2 —/(� / • y � ❑ Real proPerty ❑ Mobile Momo (I.C. 67. f-7)
II any portion of Ue residentlal sWdure w the Wnd not exceeding one (1) aue that immetliatety surmunds thai swcture is used to produte income, desaibe Ue use and portion
ol the properry utiiized m produce income.
�� �,g, ASSESSOR US�E ONLY`' � --� -? VALUE � AAT.'100%OF. T.T/ t� -HOVAIUE D�,�t 4� NON VALUENTIAL 41 F.
Land not exceeding 1(one) acre immediatety �v�,T ' z-�' �;,_
surroundingresidentialimprovements. (�) `` �.<� �
�.'�.��. ' -
':�:;a...xc}• ;� :;
Otherland (2� ' - ..,��:t��?�
Tofal land (line f plus line 2) (3�
x ; a � w �, � . �.^.
Dwelling �Q) I �� t�-F t� ��7�.a F �
.i�np'Y}``..aXta L �`� �:� � `�i
Residentlal improvements ' b ,y,.
Garage 5 ..'� �y���s4`�'3+���..'�,f ',.
1 ) �r.�..n:'.-.,. ..:�.�:;y� ..
�
Other improvements (6) - -� �- +'`";�=-.:�
��;'. .53..
Tdal improvements (line 4 through line 6) (7)
Tdal value (line 3 pl�s line n (g)
I hereby certify Ute above is We, correG, and Signature of nssessor Oate s"gned
complete.
Verifying action - SignaWre otlwditor Date sgned
``�'-ie„�5�+ :-'�.� ys�'k-:�'i :�;.._�.:F. .'���°_��[:STANDARD.DEDUCTION'ALLOWANCE _ ��.:`'''�:r.�,. .� a ::--'k' -�';��•�. .. _,
..:+�'.� .�:�. - '� R �::
20 _ Pay 20 _ �
Lesser of 1f2 Homestead
Valuafion or 56.000 S
Signature of Auditor Date signed
Gibson County Auditor
101 N Main
PRINCETON IN 47670
�
Numbcr (last 5 digits) Driver's LicensdState ID Nmnbcr (lut 5 digiLS)
.Address (Number anJ str<e4 diy, smie, and ZIP c�le)
2� � �. S�.•
I Stturin• Numbcr (last 5 di���s)
)
PmPcrtY oddrQ,— —_
1 /��-�--i--e �
A� I Same nti pmperty addres
�G
x�ow�)
undersigned certifies, under penalN of pepury, that the abo��e and foregoing infonnxtion is we and co�rect and that he or she is elieible to
:e the homesiead siandard deduction on this propeny. 6ach undersiened also understands that, by claiming additional home� tead deductions
rfi�lly, he or she may be liable for back taxes and substaniial financial penalties. �i
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