Homestead_Robb (3)..E•�,, CLAIM FOR HOMESTEAD PROPERTY TAX . veaR
e/� ;:` , _ . FORM
:x� , : CREDIT/STANDARD bEDUCTION. Hcio
:� State Form 5473 (R2/1-90) �
'' '°,• � INSTRUCTIONS: See reverse side for liling instructions.
(We)
CERTIFICATlON STATEMENT
that on the 1st day of March , 19
`(We) occupied �our principal pl� oW'residence the foll g described real property for which a Homestead
Property Tax Credit is hereby claimed: I(We) owned ❑ Are bu in under contract
� Have a beneficial interest in the entity that is liable for the property taxe� tie brn��hat owns the
property or is buying it under a contract. ,1. 8J �
CONTRACT-RECORDED
PROPERTY
Township
Legal
-�' //1 �-�3/�
If any portion oi the residential siructure or the land not exceeding one (1 j acre that immediately surrounds that struc- �
ture is used to p�oduce income describe the use and portion of the property utilized to produce income.
PROPERTY OWNED BY.CLAIMANT IN OTHER COUNTIES
hereby certify the above statements are true. correci and
ZIP code)
ASSESSOR.USE ONLY �., TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
- VALUE
Land not exceeding 1(one) acre immediately
surrounding resfdeniial improvements (�)
Oiherland (2) �
Total land - line (1) plus line (2) (3)
Residential improvemenis � - Dwelling (4) - � � - - • - -
Garage (5)
Other improvements (6)
Total improvements - line (4) ihrough line (6) (7)
Total value - line (3) plus line (7) (8)
I hereby certify the above is true, Signature of Assesor Date Signed
correct, and complete
Verifying Action - Signature of Auditor Date Signed
1989 Pay 1990
Lesser of i/2 Homestead
Valuation or $2.500
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1991 1997 Pay 7992 79—Pay 19—
Lesser of 7/2 Homestead Lesser of 7/2 Homestead Lesser of 7/2 Homestead
Valuation or $2.000 Valuation or $1,500 Valuation or �1,500
��°� �n . �'�'1 I °S��
STATE FOR\I 5I569 (R'J8-09)
APPRO\'ED B\' STATE BOAAD OF ACCOII.�TS, 2009
:ItFASURERFOR\f TS-IAI
PRESCRIBF,D B1" THE DEPMI'�fE\-1' OF LOCAL CAl'FA\1fEYT FI\A�CE IC61.1 .2-e.l
Individuals and married couples are limited to one homestead standard deduction. As the rezeipt of this
�� uction becomes more beneficial, there is more incenti��e than ever for homestead fraud. Ho�nestead fraud
:auses higher tas bills for all; therefore, HEA 13d4-2099 requires taspayers who receive the homestead
standard deduction to verif}� that they are eligible to receive the benefit and to pro��ide additional identifying
information necessary to allow county go��eroment to better monitor homestead filings. This information
���ill be kept confidential and can only be accessed by authorized counh' officials. The Departnient of Local
Go��ernment Finance ���ill use this information to create tools that will help county officials eliminate
homestead fraud.
Ta�na.�er �ame
Tem / Mary Jane Robb
Complete ared relurn !o:
Ownar t
e,R � `�
Procem' Addre+c
639 N 275 E
Princetan IN d76i0
State Parcel \umber
26-12-03-300-000.669-027
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 57670
Fvst
s3� ti �°zsc
Sadal Seamry NumGer(last 5 digits)
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Leeal Descrintion:
006-00669-00 FT SE SW 3 2 10
?.031 AC GI
i1, G„
O:her (please speWy v� P�n a bebw)
d5 p(OP2rty atlCRSS
�oQ�
Su:e � OGra (Wease sG�Y in P:ui a Dabw)
� � _...lr�.v.�s����� �u��� u . �
Each undersigned certifies, under penalty of pequry, that the above and for going informaiwn is true and cortect and thai he or she is ciligible to receive ih�
homestead standard deduction on this property. Each undersignetl also understands thai, by claiming additlonal homestead deductions unlawfully, he or
she may be liable for back taxes and subsiantial fnancial penalties.
pmer l Sg�tme Da:e
. , . n�..m.�1 nrmvc�rvz�n�e�n nrtr✓hYiv:�llearrnY.0 .� -.