Homestead_Smith (23):...
%^` •
d �o
� i:
,:��;r
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION _
State Form 5473 (R2 / 5-92) '
FORM�
HC10
YEAR
� � �l� ���
6 J
INSTRUCTIONS: See reverse side for liling instructions.
CERTIFICATION STATEMENT
I(We) ify that on the 15yday of March, 19_
I(VJe) occupied as our princip I ace of residence the following described real property for which a Homest d Prop T C� it is her y c med:
❑ I(We) owned ❑ Are buying under contract GIBSON COUNTY AUD�TQ�
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and thai owns the property or is buying un e c ntract.
� CONTRACTRECORDED �
If buying on conVact, Fee Simple owners name
Recortlers office where cantract is recorded Record number Page
PROPERTY DESCRIPTION
Counry Township Tauing dis[nct (ury, town, township)
Parcel number Legal deuriplion
- �P-� a -a - � o q..�.s3 ,� �
It any portion o ihe resideniial swdure or ihe lantl not exceeding one (1) acre ihat immediately sunounds ihat sWCNre is used to protluce income, describe the use and ponion of
Ne pmperty utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Siqn ture of cl " n
�ereby certify the above statemenis are true, correct and complete.
Atldr ss (number and sbee(, ciry, sfafe. ZIP e) '
4 �a
ASSESSOR USE ONLY TRUE TAX SESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding t(one) acre immediately �� �
surroundinq residential improvemenis.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6) -
Total improvemenis (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certi(y the above is true, fArreCt, and Signature of Assesor Date signed
complete.
Ventying action - Signature of Auditor Date signetl
�� STANDARD DEDUCTION ALLOWANCE
19_ Pay 79 _
Lesser of 1/2 Homestead r�
Valuation or 52.000
Signature ol Autlilor ' D signed
�-a -00
RAiEiORM
p(�M�
GibsonCountyAuditor � � � � � � � � �
101 N. Main Slreet . !
Pnnceton, IN 47670 ��dividuals and married couples are limi[nl to onc humcctead standard Jeducu�n. As the mceipt'i
mon bcneficial, thac is more inccmirc �twi acr (or hamesiead faud: Homestcad Gaud causcs higha
� HEA 13S<-?009 requims tacpayers wiro rccei.z ihc homcstead standard dcduction to �xrify that Ihe�
����� bencfit end to p�rnide additioml idrntifying infortnntion neces�.ry to ellow� county gm�emmrnl t�
filings. lttis informuiou uill be kept confidrncial and can anly be accesscd by auUrorized counry oF
I.ocal Grn'emmrn: Finznce wiil use this informatian ro cream [ools that will help wwR� officials e
' � � ' • I
i
— MAY 2 2011
= c�.m�
- GIBSON COUNTY AUDITOR
1433
Henry P Smith
1077 E 350 E
Princeton IN 47670
Taxpayer Name
Smith, Henry P
�
I II�I �I I
II� II� �II� I
TSIA
f this deduction lxcomes
taz bills far ell; ihcrcforc,
are eligi6lc to rcccnz thc
better monitor homc5tcad
icials. Thc Dcparcmrnc a!
liminatc Iromestwd frud.
7077 E 3�i0 S
PRINCETON IN 47670
0I� II IIII
A
State Parcel Number Leqal D,�scription
26-12-32-200-004.O6S027✓PT W NE 32 2 10 9.3:i3 AC
. �..-." _ _ _'. _ ..._._.. . . - -�.. _.. ..
1
� .�
� (
{
� �
, �
This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the cou
. . . .. r�rs� ..
P
ilcss bcr end strcct, city, stau, and ZIP cadc) � ��
o S o�-p US `�/
rity N�rmbcr (tast 5 digili) Drivcr's Liccnsr/Statc m I:immber (last 5
�
,sm,-}h
treasurer.
Same as property address �
�V �! 7� �F%�J
Othcr (plcau spccify in Part 4 y6clow)
p
;
','
>.—_. _. . � . '��Sameas
\umbR Qast 5 digiu) � Drivcr's Liccnsc/State ID
Other (plcau speci(y in Part 4�1
�
Each undersigned certifies, undecpenalty of perjury, [hat the above and foregoing information is �we and cortect and that t
receive the homestead standard deduction on this property. Each undersigned also understands tha[, by claiming additional
� unlawfully, he or she may be liable for back taxes and substantial financial penalties. � -
Owner 1 Signature � ` . Date - TNephone - •
' N.��?...��1/.� �z- z n,� � (