Homestead_SwiftCLAIM FOR HOAAESTEAD PROPERTYTAX
CREDIT/STAAIDARD DEDUCTiON
State Form 5173 (R7 � s-a�
Pras�eA by tlie Deper4nenl af Lo�l Gouermas Faw�m
INSTRUCTIONS: See reverse side (ar Amg instructions.
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FOR�
HC10
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I(We) ocapied as aa prmdpal pla<e of the foAOwirg de�srnbed real prt�perty tar which a Hanes p�ty T�c �.redt is hereby daimed:
I M�e) owne0 ❑ Me Wryug unda oontrad �/�-y��[ �
Have a benefidal "viterest m the enEry Mai is liade fa Me poperty t�es m the pioperty and tl�at owns Cie"prc�pee�w is�under a contract
r.atGON COUNTY A D OR
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° a. _ CONiRACT;RECORDED}..:a': '.°�.'s..� , ti �` S ,S';',::e..� 1.� a.,: ��.'.F'7:«,:?r.t;
If buyig on mrNacl Fee Sirt�le uwnefs reme
F�mde/a dhg Wiae mr4raq is recardetl Reard number Pege
Tart¢hip
Ta�g digrit (dy,
rcel � Legal desaiP� Ls tl�e
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Oi bIB pIOPBlry Uil� 10 PIOdIICB CImIfIB.
n ques0on: V
�al qoparry ❑ MoEib Fiorte (/.C. 61.f-� -
s9ae ia usetl b pmdice nmrtie. tlasome Ihe m and pwtim
. :� . . �, ; % ` 7f�lE TAX 0.SSESSED.VALUE F�STEAD a NONiiESiDBliUIL�� �
,�.,? . � tASS6SOR USE OPILY � �:. � n „ i �.. ;. V/LLUE; . • .. . AT 100X OF TTV � . ': VALUE � � "T`? VALUE +� „� s�'
..r ,�s ». .u.::�..'�b, a�.
Lm�d nW esceeding 1 (one) aae imnediatety . . � - < ��'�•�41r � r^`, : .,�t* �'=�
s�vrwmd'ng residential impoyemen�. G y �r�, �'i�u;1 t i,� �k•+�s��ra,`
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OUlef �Blld � �:,�E,''$����: �
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Tdal land (lire 1 pku 6re � �g)
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., � 'i ��` itv�r.��y��A�
R��85�id�en�tiJe�l 4vnLpyrOVe��m�e.nit5 �or�M�rwally ���9 i4) ;., 1+x "�'�,si)Fl� toj o i�'.�;;r1'�'�..��*:/.�f��i
NFiIC�lTWW�nmW�n1AYW�� ' .�V �fi`�yp..l�+l,jp( �'���"��Y/4r
��e �`S� %'��41jti'���4� (.S �?S�:X^i?il,{�.��
Qi�IBf RfIpfWCfflEfl�S �s� �t:.�
Tdal "vrryrwements (fine 4 tivou� Bne 6) (�
Tdal value Qcre 3 pka Gne n (g)
I hereby cer6ly the above's We. oortect. ard S�g�se ofAss�sor Date sg�ed
cornplete.
�M�e amm - sigreaae af ai6mr Dam signed
24 _ Pay 20 _
Lesser of 12 Hwnestead
V�uatian or 535,000 S
STATE FORM 51569 (PJ/A-10)
APPRO�'ED B�SiATE BOARD OF ACCOII\TS, 2009
TRF.�SUftER FOR?f TSIA
PRESCRIBFD BY i}[E OEPMTF(E\T OF LOCAL GOVER\�@\T Fl\A\CE IC61.1 S'-e.l
Individuals and married couples are limited to one homestead standard deduction. As the receipt of'this
�eduction becomes more beneficial, there is more inceotive than ever for homestead fraud. Hnmestead fraud
•causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead �
,standard deduction to verify that t6ey are eligible to receive the benefit and.to.provide additional identifyirig
informationnecessary to allow county government to better-monitor homestead filings. This information
, will be kept confidential aud can only be accessed by authorized county_officials. The Deparlment of Local
�. GovernmenfFinarice will.use this information to create tools that will help county oflicials eliminate�
homestead fraud. �
Taaoarer \'ame
Gena L Swift
Complere and return to:
.C'.�+'i
Prooem Addrns
1390 E CONSERVATION 1 AKF
PRINCETON fN 47670
Slate P�rcel \umber
26-12-OS-400-704239-027
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
Fvat
/i%
MiCtlle
Lexal Descriotio�.
BLDG ON ISD GRD -
CONSERVATION LAF:E LOT 14
TRS F � W CONS
2fi-12-OS-4�0-000.570-027 G-2-101
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���- �° ' ' —"'�� —' "' """"' ��I Sama as property eENess
/390 6. G»s�: ✓�n.� Dz. � "
.
sv«�sa Firs� . � . ... ... . .. . . . �a - . . . . �es�
N�R — N�A � . N/A .
Social Sxuriry Nw�Eer(last S hcpib)
Drivers LicanseJStaro ID NumOer
se�,e es o.wam aaarev
6wa � ptMr (please sperify in Pert a belax)
Each undersigned certifies, under penalty of perjury, that the above and foregoing intormation is true and corred and that he or she i= eligible to receive the
homesiead standard dedudion on this property.. Each undersigned also understands that, by claiming additional homestead deductio�is unlawfully, he or
she may be liable for back taxes and substantial financial penalties.
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