Homestead_Burgess SLIME FORM!OtA,RU YVl f asuiIl PoRM 75-IA
APPROVED BY[FATE BOARD OF AM1'O:T:S.'On PRESCRIBE BY fir BEPA0.neT Or LOCAL e{R'ELVMrn FINANCE MH.I r-i.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to otie homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than net-for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-200'requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying_ information necessary to allow county goernment to better monitor homestead
filing-.This information will he kept tont:dentinl and can only he accessed by authorized county officials.The Depanment of
local Government Finance will me this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Burgess, Mark A/Marla K
2010\V Bmmficld
Princeton IN 47670
398
Mark A/Maria K Burgess
2010 W Brumfield State Parcel Number Legal Description
Princeton IN 47670-1034
ItltdLtJJlttLtJll 1111 1111Lllrrr111Lrtlrrr11 k 26-11-12-103-002.483-028 21aW1 00 TOWER HOTS 200W128
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
ing Address(number and street.city,state,and ZIP code) Same as property address
�L0\o \/ BPk-m,Ft Lb AvC .
.
Spouse First Middle Last
MAR LA K 13( .KGEs 5
Mailing_Address(Number and street,city.sate,and ZIP code) 'Same as property address
201 0 vJ ii&IA,mevT. ELn A4 E
=� " _ � • .
. . -'- PART 3:CERTIFICATION � "`— -------
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eligible to
receive the homestead standard deduction on this property.Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date
•
e��"� ; CLAIM FOR HOMESTEAD PROPERTY TAX
d CREDIT/STkNDARD DEDUCTION .
i'�f
��
` Sta;e Form 5473 (R2 / 5-92)
.au
INSTRUC710N5: See ieve�se side for filing instructions.
- - ' � � , - . .'_ - �� CERTIFICATIO
_E~ i�i' ' � !,n_
� • 11
•
j;) occupied as our principal place of residence the following desEri6ed real property for which a Homesiead Pmperty Tax Credit is hereby claimed:
(/
I(We) owned .❑ Are buying under contract , -
Have a beneficial inieres� in ihe entity ihat is liable for Ihe property taxes on the property and thai owns the propeny or is buying under a contract.
- � �- = -.. �� CONTRACTRECORDED � ' - -� . '-
It Wying on contrac6 Fee Simple owner's name � � . . . �
Recortler's office where contwa is recorded Record oumber Page
ponion a
pmperty
m
Township
g ription
stmaure or the land not exceeding one
ce inwme.
PROPERTYDESCRIPTION
Tazirg disVia (ciry, lown, townsAip)
^ / F
I that immetliatety 5urround5 ihat struciure is usetl to
income, describe ihe use and ponion
PPOPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Cauniy TownShip County Township
�eby certity the above statements are ime, correct and complete. Siy^amre o� ciaiman�
X
Address (number arW street d. state, ZIP wde) �
O �
��ASSESSOR USE ONLY TRUE TAX ASSESSED. HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately �
surroundingresidentialimprovemenis. (�)
Oiherland (2� �
Total land (line 7 plus line 2� (3)
Dwellin9 (4) . -
Residential improvemenis
Garage (g) _ �
Other improvements (6)
Total improvements (line 4 thiough line � (7)
7otal value (line 3 p6s line 7� (g) I
I hereby Certify ihe abOVe i5 �rue. CorreCL and Sgnature of Assessor Dare signetl
complete.
�„�'virg action - Signanre oi Auditor Date signed
�
19_Pay79_
Lesser of 1/2 Homesiead
Valuation or 52.000
DEDUCTION ALLOWANCE
3
signetl
_ '_ i