Homestead_Rice� �-.Ym��' c�' `
a`�r �R ; CLAIM FOR HOMESTEAD PROPERTY TAX FoRM YEAR
CREDIT/STANDARD DEDUCTION HCio �
3�• �• Stare Form 5473 (R2 / 5-92) '
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, INSTRUCTIONS: See reverse side /or7iling instructions. •
' - CERTIFICATION STATEMENT - --�
I(We) �___ � , _�� V�,�� certify thaf'bh 4fle ts�day'Of March, 19�
I(We) occupied as our principal plac f residence the following described real property for which a Homesiead /P/roperty TaxI CLredit is hereby daimed:
❑ I(We) owned ❑ Are buying under conirac� l�('iYV)�-.2�I '(�C'7� •��'S
1� Have a beneficial interest in the entity ihat is liable for the property taxes on the property and that owns the pmpert�}'�Sb�TinOg�under a contraci.
� � CONTRACT RECORDED - .
If buying on contract. Fee Simple owners name - . � �
Recorder's oHice where contract is recortletl Record number Page
PROPEPTY DESCRIPTION
County � Township . � �•Ta�cing district�ity, town,
Parcel number Legal description
OO�v- r`�IhSD-Fb P�S.t.�r,� �- I-/D ., g.
I; any portion of the residential strucNre or the land not exceeding one (7) ave thai immediatey surwunds ihat sWC[ure is used to produce income, describe ihe use and portion
of Ne property utilizetl to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Counry Township Cauniy Towns�ip
I hereby certify ihe above statements are irue, correct and cnmplete. Signamre o� ciaimam
�ddress (num6erarMstwel. ciry, stare. ZlPCOde)
. ASSESSOR USE ONLY TRUE TAX _ ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE . VALUE
Land not exceeding 7(one) acre immediately
surrounding residential improvements. (�)
Otherland (2) �
Total land (line 1 plus line z) (3)
Dwelling (4)
Residential improvements
Garage �g) _
Other improvements (6)
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � ��g)
I hereby ceni(y ihe above is true, correci, and Signature ot Assessor Da�e si9netl
complete.
Ventyirg aaion - Signature of Auditor I Date signed
79_Pay79_
Lesser of tl2 Homesiead
valuation or 52.000
SignaWre of
STANDARD
Gibson County Auditor
101 N Main
PRINCETON IN 47670
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�Ul£lOR.N �)!NIR`/)WI
MASURCPf00.43�A'
PAiYFIBmBY iNF UE�A0.TRYf fF IfML fM'EIIVM(t.i iQ:AVfE IC 61.IS-J.1
Indiridua6 anJ rtu:rinl couple. are IimiieJ to onc honu�eaJ �andaN d:tluaion. As Ne rereipt ol Nii Jnlunion beconxs
merc bcnefiNal, therc is more incemn< than ncr (or hommral fraud Ilo'm;eacl fraud causes higher ta� Eilis lor all: the¢fae.
HEA Il Li-?OM requim uapa.rn x�ho �ecciae the hanes�ead siandard deAunion to reri(y ihat tM1ry am cliciMc to mcei�e �h.
bznefi� an1 m p�a�ide aJJiiional iJentii��in_ informar,un nm: -vrr io allw��counn� gm'emmmt ro bevef munitw Iwmcs�<aJ
filin�.'Iliis infarmation will M AqV eimlidcMial anA ran only M: arces'v.tt M1r au1lroriuA counly nfTrtiul.� 'Ifie Ik�nmcnl nf
780
Terry / Colene Rice
2839 N SR 65
— — Patoka IN 47666 ` — — J —
Taspa�•er Name
Rice, Terry / Colene
k� �,�t �j� � p�
Pa�oAa IN �t7666 -(� �
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State Parcel NumAer Leeal Descrip'tion
_._ 26-OS-2&300-001.650-0 7 Oo5-o1650-oOPTSW�281-10-.aarAC.
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Oaner I First hliddle � Lasl
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�err I �a �c i
��e Addrecs (numbcr ana s�eat. <iry, stn�c, and Lf F codcj Same a. plupm ad� �
�-`� 3 � �i/ R — �a-b�1c� .�n/ `��� �o G i
Socol $ecuri�y Numba (last 5 dicits) lhiver's Lim2�e/Siate ID Number (lut 5 digiB) Oth<r (pleast speci(y in Part 4 below) �
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Spou;e Fi�st Middlc ' Lui
Cd�e%? �L l' 4ye �� °L. �
Mailin2 Addrtss (NUmbcr anJ avttl cin', te, and "LIP coJe) �e ns pmpem addrtss
d 0 � i� �0.� �a'i0�fa �/U "/ 7V � � �
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- Each undersigned certifies, under penalty of perjury, that the above and foregoing informatiun is wz and wrtect and that he or shc is eligible to
receive the homesiead standard deduction on this propeny. Each undersigned al;o undemands that, by claiming additional homesiead deductions
unlau�fully, he or she may be liable for back taxes and substantial financial penalties.
Owncr I Si t�ac ' [h�:
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