HomeMy WebLinkAboutHomestead_Stevens (7)�. ' CLAIM;FOR HOMESTEAD RROPERTY TAX
CREDIT/STANDARD DEDUCTION
t State Fwm 5473 (R6I4-03)
' Preacribe0 by Na DeDartment of Lacal Govemment Finance
� INSTRUCTIONS: See reverse side for (ling instn�clions.
FORM � YEAR
HC70
��i:�,�-;� � .- ?,,. Y,'"�e. .�:T�iZ;""'�.(:CFillt A N:STA7EMENT`:��t�_. :�'F ' .'
� i�'�e) . . ...� ._. .+ , certity thal o e.. s a f�Mer 0�
I(We piedias o r 'ndpal place of dence Ne t owing describe real property for which a Homestead Pmpe�C�dit h e�t
I(We) owned ❑ Ara buying under conVact 1L 1L
ave a banefidal intarest in the enUty Nat is Iiabie for the property taxes on the property and that owns the property or is buy�Rind�r �c6rtl�`3�.
If Wying on conVect, Fae Simple ownefs name
Rxwdafs ofice whera convaa is ramded
Counry
County
Tpvnship
Tacing tlistrict
GIBSON
Record number
' J( j/'��7 /� I�ql descriPtion I Is Na property InReai D DertY ❑ MobOe Hwne (I.C. 6-1.7-n
77To:�;V
ddantial strucWre w the land rwt exceeding ona (1) acre Nat immediately surtounds Net struGure is usad to Droduce IMOma, descnba the use and portion
ta woduce income.
To.vnship
I hereby cer6fy the above statemenLS are We, cortect and complete. ,�
/ � .�
�(number aIM sLeet, Cjry, atgte, 21P qeQe) �
Land not exceeding 7(one) acre immediatety
surtounding reside�tlal Improvemenfs.
Other land
Tctal IarW (Ilne 1 plus lfne 2)
Residen6al improvementa or Mnuaiy �����9
Pssessed Moblle I ManuFadured Home
Garage
O�kerimpmvements
�k
Tctal improvements (line 4 through liire 6)
Tdal value (line 3 plrs line �
I hereby certiry the above is we, conect, and
completa.
Venhv�q ecUOn - Slgnstura of Auditw
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation or 535,000
Sipnature at Puditv
(�)
(2)
(3)
(41
(5)
(6)
(�)
(8)
SignaWre ofASSessor
S
i Date signed
Date signe0
a
Gibson Counry Auditor
101 N Main
PRINCETON IN 47670
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APR g �uw
fUiE fO0.N ��M IR'/ faMl
1RElS11lERlOR4 iS1A
InJieiduals anJ mxriN muple. are limiitd w nre home�caJ aandanl Jniuciion. As the rtteipt of this deJuctinn becomes
morc beneficial. �hrre fs morc incenma dun ner for homes�ead fnud Home�raei iraud causs hi�M �n bills for all: rhercfore.
HEA Ii34-2IXl9 rcquim u�pa�ers who receivc Ihe hanestmJ standard Jniunion to vcri(y iM� �he�� are cliciNe to recei.e the
benefi� aM to p'a'idr adlitimul iJentiiyin_ infwmatwn Mcessary ro allw' cwnrc grnemmrnt tu Nner�monitor MmesttaJ
filin�,�.'ITiis info�ma�ion vill br le}v confidrniial anA esn only Fc aaresavi br autFwri�N rnunp� officiais. T6e Ikpannrcnt of
Local Gmemmrn� Pivnce �cill ux this infoemation ro crcote 0.wL �hat mill h:in cvuntt offioal> dimfnate humn�ead fraud.
GIBSON COU � A�DITOR
John M Stevens
2576 W Julie Dr
PRINCETON IN 47670.8120
�i�u��rn�i��n�in���iu�n�i�u��ii�i���ni�ni�i��i��i�i��
Taxoacer Name
Stevens, John M/Gayle L
P o E3ox
Odon I\ i
State Parcel Number Leeal Descriotion
26-11-15-101-003.948-027 006-03948-00 SANDY�RIDGE EST C 22
D-17 �
" This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the county
0
¢ Address (numbcr end sam, ciN, smte, end ZI P code)
J �i l__. �
� ����
sveeL �iiy, sw�e, and ZIP cak)
Snme as pmperty odd�¢;
...� ,. 1
Olhcr (plcact specify in Pan 4 below)
I Ste�1 �,t
j�l $amc u propeny addrtss
14
(laz� 5 digi�s) � Otha (plcase spccify in Pan 4 bclow�l
undersigned cerrifies, under penalty of pequp•, that the above and foregoing infortnation is we and wrtect and t}ut he or she is elieible to
�e the homestead standard deduction on this property. Each undersicned al;o understands that, by claiming additional homestead deductior
�fully, he or she may be liable for back taxes and substantial financial penalties. I
�I S�ig��t{Ge , Ua'te! l'dephonc _
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