Homestead_Stevense�. R.,,
;; �^ 4 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
'� CREDIT/STANDARD DEDUCTION
�,;�� State Porm 5473 (R2 / 5-92)
4�. . . . . ' ._� _ '
INSTRUCTIONS: See reverse side lor liling inshuctions.
!.C�P " �
' � CERTIFICATION STATEMENT - � � `
I (We _ � � %.�����.�lN� certify ihat orj,lljp�1;t1laypyM - .
,�') c upi as our principal place of residence h following described real property tor which a Homesiead Pmperty Tau C� ���� aimed:
I�I (We) owned ❑ Are buying under comract
Have a beneficial interest in the entity that is Iiable for ihe property taxes on the property and that owns ihe property or is buying under a contract.:
- - CONTRACTAECORDED . ,
It huying on contract. Fee Simple owner's name , � •
Recorder'S oHice where contract is recorded Record number Page
Counry
PROPERTY DESCRIPTION
Taxing district (ciry. town. township)
�c�o�-ob��7-e�c� �= s� a9-a-�o I.oc� ct,.c -
I( any ponion of the residential sWCWre or Ihe land not exceetlinq one (7) ave that immetliatety surmunds that strucNre is usetl to produce income, deuribe ihe use and portion
o� Ihe properry ulilized �o produte income.
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
, VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding resideniial improvemenis. (�)
Otherland (p)
Total land (line 7 plus line � (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 through line � (7)
To�al value (line 3 p�s line � (g)
I hereby certify the above is true, correct, and Signature of assessor Date signed
complete.
Veriryirg action - Sgnature ot Autli;or Dare signetl
�
ALIOWANCE
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000 S
Gibson County Auditor
101 N Main
PRINCETON IN 47670
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��� Wti� :s��
rRr�uam or m� oer,viwvrar
IndiriduaL anJ macrieJ couple am limi�ed io ore IromeweaJ uan�LtN dedunion. A� ihe recerpt ol �hi� Jeduc�ion become..
mure beneficial, therc i. marc incrnm�e than e�er for home.teael (raud. Ilomesrcad fiaud causes higher bz bills (ur aIC [herefore.
HEA IlA-l-70119 requims u�pa�m who reccivc �hc hwnestced slandard JeJuc�ion to verilj tlul lhey are clieiNe lo rccei�t �h.
brnefit anl to p�m'ide OlWiliUNl idrntii}'in_ fnfomunun nece:san' to allw' aounn� emrmmem ro Mner mmlmr IwmesreaJ
lilin�,�. This in(nrtw�inn xill he Arry confii?rn�inl and r.in only he acm.avl br awhnrizeJ rnuniy olTcivis. The Ikpanmem of
i
I.ucal Gmcmmrnt Financc efll u.c this fntormation W aream [c�ls �hm �cill h;Ip counn� oti�icials climinA: humcthad fiauJ.
4130
Jay P/ Debra J Stevens
1076 E 350 S
Princeton IN 47670-9217
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� Address (numbcr and �aect city, sutc,
$eeurity Numbtt (las� 5
ailin� Addrts (i�umber and sVtt4 d�)', sWle. nnd "LIP cutk)
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Kial Stturiry� Number (last 5 digics) Drivcrs Liccnsc/S
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alelUNmnber (la.�
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put5
TLSpB\'ef �LO1P
Stevens, Jay P/ Debra J
io�a e s<
Printtton IN
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State Parcel Number Leeal Description
26-12-29-400-000.887-0 7 �����-� PT SE :?9 2 10 1.06 AC
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ach undersigned certifies, under penalty of perjury�, that the above and foreboing infurtnatiun is trve and cotrect and that he or she is elieible to
ceive the homesiead siandard deduction on ihis propeny. Each undersiened al>o unders�ands tha4 by claiming additional homes1ead deductions
ilawfulh�, he or she may be liable for back taxes and substantial financial penalties. '
+�ner 1 Signanve Ualc 7'clephonc
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