HomeMy WebLinkAboutHomestead_RoachCLAIM FOR HOMESTEAD PROPERTY TAX
-- � CREDIT/STANDARD DEDUCTION
SUte Form 5473 (RS / 7-07)
��a. '� Prexnbed by Iha Deparirrrenl of Local Govemment Finance
INSTRUCTIONS: See reverse side /or filing insWctions.
FORM
Hcio
YEAR
��^'e� /'{ �� Y 1T � certiry that on tr(� ��F e�y � A�i� zp
I(We) occupied as our prindpa� place of residence Ne folbwing described real property ta which a Homestead Property 7ac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying undef mntraU �y„� ���
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❑ Have a benefidal interest in the entity that is Iiable for the property taxes on the property and that ovms the pro]p-.��rty or is buyyig undela contraC.
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If Gry'v�g on wnVaq, Fee Simpie owners rama
Recordefe office wheie conttsd is
Counry
. �
tt arry portian M Ihe n
of �he property uGdm
oi9 �D`�o8 �
I he2by certily the
Land not exceedirg 1 (
surrounding residential
Other land
Twnship
Tadng district (cify, fawn. IamshiP)
Recofd number I Pape
I�— �I �a� =cn up -on I Is �he property'vi queslion:
� �� ❑ Real
`� property ❑ Mabile Home (IC 61 7-n
rNal sWClure or Ne IaM not ezceedirg orre (1 J acre ihat immediately wrtounds Uat structura is used b pioduce inwma, tleunbe Ure us¢ and poNOn
iroduce inooma.
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ab��� yg � \
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�E\��7� �� �•` complBtB.
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Tdal land Qine 1 pios I'me 2)
Residential improvements or Mnuaily
Dwelling
lissessed Mobile / Manufachued Home
Garage
Other improvements
Tdal improvements (line 4 through Grre 6)
TUaI value (line 3 plus fine n
I�Sy certify Me above is true, correC, arW
Veritying
Caunty
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(Z)
(3)
(4) i
(5> � � Y
(6) �
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SignaWre of Assessor
20 _ pay 20 _ qs p�p for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser af 12 .. ,,.�...__ .,....e __. .. ...... ... ...... . ._ _ �....
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signed (monfh. GaY•Y��
signed (month, day, yBar)
�`_ �
Gib� n County Auditor
101 N Main
PRINCETON IN 47670
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1�i�o�-� �� �c
InJiriJuaL anJ mvriN toupks arc limi¢d �o ore home�caJ �tandaN AcAunion. As ihe rttcipi of tltis'dnluttan heconms
mare benencial. there is morc incrnme rtun e�er for homoiexl fr�wl. Ilomesrcad fraud causes hi�her ta� bills tur all: therefae.
HEA G4-i-21%W requim mxpa�en M'ho receire IM1c hwnesteaJ smndard Jnluction m.eril',v tha� �hcy are e1�ciMe to meei�e the
br t ani ro p�w'ide adJitio�ul iJentiirim_ infurm�twn nems�ry b allw' cwnq' gm'rmmrnt �o Nner �moni�or Iwm�euJ
lilin . Ihis inl'armmion aill M Aryw con�iArnlial and r.in onl} fc arae: snl hq amhnrizeJ oonnly n(fiai�als.�TM1r Ucpanmem nf
I. Gmcrtunem fi�u�e �vill u.e this intormaeion tu crcatt 0.wls �hat will hclp �aum' uiTicials dimina.e Ix�m<7cm1 fiauJ.
— � � 20�U
PQR � ,�,
1889 a" U�h'"(J��`gtla
G�gSO
Freddie L Roach
2595 W 50 S
PRINCETON IN 47670-8125
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Tasoaeer N•ame
Roach, Freddie L
k� aor i
I'rincetnn I\ .
State Parcel Number Le�_al I
2G71-15-202-001.517-027 ooP 01517-00
��na 1 First Middle
f=2 c��l�l. -� /u� �� „ � ��
ig Aadress (numbc7m�d sacet cirv. sum, sndZiY codej — . - . ..�.
�� y'S �-t� -J�O �'. �� ," n e � � o �, Zitl
reial Sccurity Number (last 5 digils) Uriver's LittnerJSute ID Nmnber (lut 5 digils) Other (plcue sptci
Address (Number end slree4 ri�y, slate, und "LIP cak)
Sccurity Numbcr (laa 5 digics) � Drivcrs Liccnsc/Statc ID Niunbcr (Isc� 5
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pruRrtynJJraa; ' '
�� 7� 7 0
� $ame as pmpem add`as
4
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EST SEC A
idersiened certifies, under penalty of perjup�, that the abo�•e and foregoing infortnation is We and correct and that he or slie is elieible to
the homestead standard deduciion on this property. Each undersiened also understands ihat, by claiming addiiional homestead deductions
illy, he or she may be liable for back �axes and substantial financial penalties. I
T��ner I$i pve Uate Tele harc
�ed�c �y�-k�lc. �C���Fi: 'i��c -/O �
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