Homestead_Riley (8)� CLAIM FOR HOMESTEAD PROPERTY 7AX FORM YEAR
? CREDIT/STANDARD DEDUCTION HCio
�� State Fortn 5473 (R6 / 4-03)
Prescribed by the Depanmenl ol Local Govemment Finance
INSTRUCTIONS See revc�s� side �or lding insl�uc(ions �--' � �
�°�r1�...�,a�S:r=�."ru'��°_�3�,�..'�-'.�=:�� _ � �'�-�'CERTIFICATON-.STAlE_ . _ ":�a�'a3��.1.,'4*'S�� ��� �_ �*:-._�l� s. �''9- '�'��:��
��e) . � certify ihal on t o ffi�ry 20
��� �� �UY '
I(We) occupied as principal place of reside the following descnbe al r erty for which a o estead Property Tac Credit is hereby daimed:
�•
❑ I(We) owned ❑ Are buying under contract ' ` ////// n
❑' Have a benefidal interest in ihe entlty that is liable for the property taxes on Ihe property and that owns lhe property or is buying under'��tl�aA.
•�rv�Tn^ '
If buying on contrad. Fee Simple ownefs name
Remidels ofice where mnuad is
County
�� 1���
Toxnship
Record number � Page
dislrid (ciry, fown, township)
Is the property in quwtion:
❑ Real property ❑ MoDile Homo (/.C. 67. f-7)
If any portion o/ the residential sWCWre w Ne land nW exceeding one (1) aaa that immetliatety surtounds Nat shucture is used b produca income, aeunbe Ue usa and portion
ol the property ulilized to produce income.
���g��L
: -;��
Gibson Caunty Auditor
101N M' SV t
RAiEfORM
81f1 ee �ndi�iduals v�d married couplcs art limited to one homestad staudud deduttiou. As che rcceipt'of thi� Mluctim bemmes
Pfi0CRi00, �i� 4�6�� � more benc(rcial, Ihere is morc inttntirc Ihan nct (or homcslead faud. Homesttad f2ud rauus highei�tax bills for all, thcrtCore,
, HEP. 13M-?009 requires taxyaycrs aip�rccei�x thc homestead standard deducuon to �xrify ilut the� are cligible to feccne the
w F I�L E D �efit and to prrnide additimul idrntifying in(ormniion nttcssarv in allow cmmty gmemmcot t� better monitor hm.nestead
6linss. This information will be kept wnfidcntial and tan onh� be acccssed by authorizM cocnry eficials. 7fic Deparcnent of
Laml Gm'emmrn[ Fi�tance will use this information W crtate lools that will hely cnunry ofHcials elimi�ie Iromestead frzud.
. . _.. . _ " ' ' ' —
_ • APR 19.2011
= C�.n�
GIBSON COUNTY AUDITOR �.
180
Jackie R Riley Jc
1763 N 150 E o
PRINCETON IN 47670-8640 �
�����'I'll�l"I�'�II�'�'I'�I�IIII'll�'lllll�l'���III��II'�II���I'
9
Taxpaver Name � Location Address
Riley, Jackie R Jr/Amy J {
� 7763 N 1 i0 E
PRINCETON IN 47670
�.
I Ilul �I I I� �II� II I IW ullll �I ul �II� I I� II� II� �Ilu II� II� I II ul I�I I I I I' ull0llul �I0 II (I
State Parcel Number Leqal 0
26-OS-32-400-004.147-027✓ PT SE SE 321 10 2
This form MUST be returned to County Auditor's office. �
Please do. NOT send this form back with your tax payment to the coun,ty treasurer.
hivcr's License/Stau m i�umbcr
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5 digits)
E�
� Same az pmperty eddras
Otha (pleau specify in Part
Swe
�K, �2�/ {
ne as pmper eddresi—"r—�
1
�
Od�u (please spaify in Part �� below)
undersigned certifies, under penalty of perjury, that the above and foregoing infonnation is We and correct and tha[ h� or she is eligible to
;e the homestead standard deducrion on this property. Each undenigned also understands that, by claiming additional � omestead deducnons
�fully, he or she may be liable for back taxes and substandal financial�penalties. ..
� g��yp� . ,�. � Date �
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