HomeMy WebLinkAboutHomestead_Shamsaied� °� CLAIM FOR HOMESTEAD PROPERTY TAX
;r�'� CREDIT/STANDARD DEDUCTION
..�.;; � State Porm 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side lorliling.instructions.
� CERTIFICATION
FORM-
HC10
�
r i
��We) _ " e 7st day of March, 1�
�e) q¢cupied as our incip place of resi nce the following descr" ed real property for which a Homesiead Property Tau Credit is hereby daimed:
�We) owned ❑ Are buying under coniract �y��.��,
❑ Have a beneficial inierest in the entiry that is liable for ihe property taxes on ihe pmperty and Ihat owns ihe pr�p�y�r�buyp�unqQr �ontrect.
aa a �n h u
. CONTRACTRECORDED . '�
If buying on contract, fee Simple owner's name � . -
Recorder's ottice where mntraa is recorded � r .Page
' � " AUDITOR
County � Township
� .»�' .�� �
Parce—�nu�—e`r�n n / Leg�a�l d/e�
� `LO���07 B� I .C.H./.
If any portion of the residential stmcture or the la d no�
of ihe pmperty utllized to produce income.
PROPERTY DESCRIPTION
Taxinq di,5tnyj'(
i
swcture is used to produce irmme, tlescnhe Ne use and portion
PROPERTY OWNED BY CIAIMANT IN OTHEH COUNTIES
County �
�reby cenify the above statemenis are ime, correci and complete. Sgn re Iaimani .
4 �
Address (number and street, ary. state, ZlPmde)
� oT \ a,a �� nc��ii,� 1tJ. �
ASSESSOR USE ONLY TRUE TAJ( ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately
surmunding residential improvements. (�)
Otherland (p)
7otal land �line 7 plus line Z� (3�
Dwelling (4) �
Resideniial improvements . .
Garage (g) - � -
Other improvements (6) .
Total improvemenis (line 4 th�ough line � (7) �
7ota1 value (line 3 p�s line � (g)
I hereby Certity �he above is �rue, CorreCl, and Sgnature of Assessor Date signed
complete.
ntying aaion - Siqnanre of Auditor Date signed
�
1�Pay 193�G.!
Lesser of 1/2 Homestead
Valuation or 52.000
Audimr
5
�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
1877
.v.�rz rana.�w�x: i urv�
nr.+su�rn wzW rsu
IndiviJual> and inarriN roupb arc IimiicJ to one hnmc�caJ vandaN dcvluninn. ds �he rcmipt ot �his �dNuninn Mcomes
more beneficiaL rhere is more incentne than e�er for homea'rcad fruuJ. Homesrea�i frauJ causs hithrr ta� bi;l> fur all: therefae.
HEA 134-}-21%19 «qu"vn uxpa.en �ho recei.e tM1e MunesiraJ standard JrJuction io .erify dut �hey are eli_iNe to rccei.e th.
benefit anl tu pnn'ide a�lJiiiunal iJrneiiyin_ iniormatwn nece.vrv to allw' counn go.'rmmmt ro bener�monnw IwmrsreaU
filinf�.77iia inln�mmion will hr Aryu mnlidemial anA ain nnly F.: arre:uA hy au�horiznt munp' o�7iciuL..ITM1e Ikpanmem nf
I.ucal Govcmmcm Fi�uncc will u.c this inio�.na[ion W arca;r 0.ds �hat aill h:In �mn' ufficiaL. dim��ic Ixim<nhad fiaud.
Shayegan / Shelly L Shamsaie
2541 W Julie Dr
Princeton IN 47670.8120
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Taxpaeer Name
Shamsaie, Shayegan / Shelly L
>hay eet� � —
c-nAdiiss �mim�cr�ond sven. rirv. su¢. emi ZIP codcj '
`a.SV1 �.1 . J�\:� ��. �ir;�ca�°c� �N.
Securiry Numbcr (lan 5 diei's) Urivcrs Li a�r/Stam IU Nmnber (lasi 5 divils)
L.
as4i W�,S�I,� l'i,.
Princtton W
�
State Parcel NumAer Le�al Descripfion
26-11-15-101-002J67-027 146-02167-OO SnNDY�RIDGE EST SEC A
ne Addrtss (Number and strce4 riiy, staie, anJ LIP coJe)
���� W �� ��',4 �r. �r�n�"� � -�'N'
I Stturiry Numbcr (laz� 5 digits) Drivcr's Lifcosc/Statc ID N�unbcr (1azt 5 digi�s)
�
y�ho-,�s a. �
�Sume m propcm' ai',ss;
�1�lfl�l-o - �\ a,0
Oiher (pleue specify in Patt 4 bclaw)
Sh
proprny add�es;
Ochc� (pinsc spccify in Pan 4 bclow)
mdersigned certifies, under penalry of pepury, [hat the above and foregoing infortnation is true and correct and that he or she is elieible to
e the homestead siandard deduction on this property. Each undersiened al;o unders�ands thai, by claiming addiiional homestead deductions
fully, he or she may be liable for back taees and substantial financial penahies. �
I Si��Untc 'I'cicphonc �
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