HomeMy WebLinkAboutHomestead_CederholmCLAIM FOR HOMESTEAD PROPERTY TAX
` - CREDIT/STANDARD DEDUCTION
� � State Form 5473 (RS / 10-01 � .
Prescribed by Ihe Department of Local Govemment Finance
INSTRUCTIONS: See reverse side /or �ling insVUCtions.
FORM YEAR
�'; ��`HC10� ���
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JUL l'� L��3
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�(We) " _ cef r6fy,that on ihe.ls day M��20_
I(WeJ occupied as our principal ace of residence lhe following cnbed real property for which a Homestead;P.iuperty�T�c Credit is hereby daimed:
/
t�J I(We) owned ❑!va buying under contract
� Have a benefidal interest in ihe entity that is liable for the property taxes on the properry and that owns the property or is buying under a contract.
If buying on contract, Fee Simple owneYS name
Recordefs ofice where coniract is remrded
County
Tawnship
P�ln 1 �v� O�v I ♦ �d�.CJ1.N\/YVf
N any poRion ot the residmtial aW cture w the lan nd e�
af Ne propeAy utilaed to produce irroome.
Twvnship
I hereby ceAify the above statements are W e, coned and complete.
�iress (number and shpeL ciry, atate, ZIP code)
Land not exceeding 1(one) acre immediatey
surrounding residentlal Improvements.
Other land
TUaI land (line 1 plus line 2)
Dwelling
Residential improvements
Garage
OtF�er improvements
Tdal improvements (line 4 through line 6)
Tdal value (line 3 phs line �
I hereby certify ihe above is We, corred, and
complela.
Verifying adion - Signature of Puditor
I�1
IZ)
(3)
�4�
(5)
(6)
(�)
IB)
SignaWre of Assessor
nh kit t wn, township)
�. W<�:
Is the property in Qu Gan:
eel prop
wnds Ihat swcture Is used
i `/�.f-
Signature otdaimant
Record number � Page
iRy ❑ �debile Homo (/.Q bf. f-7) .
lo protluce income. describe Me use and portbn
TwvnShip
Date signed
Oate signed
'�'•�,��n �'�a•-�o5�''�+v��"�z'�3'�`=:STANDARU'OEDUCTION�ALLOWANCEc,.�"��»��.'.s�:�',.•��'j=�.€�"`;`2��`�,r�pF,s��`=n,�'�
. _. _. ._ . _ . _ _ .
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuafion or $6,000 S
SgnaNre of PuEitu � Date signeC
�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
SIAtElOAM�!!NIR:f�I
iRFASU�FA PoR4:S1.�
L�diviJuals and nu:rieJ rouples are limiied �o oce home,�eaJ aandaN JNunion. .�s �he receipi o( ihis Jeduninn bttonres
mere bcnefidal, there ic morc incentn< than ner (er Aomestead fiaud. Ilomeittael fawl causes higher Iac bills (or all: therefore.
HEA 1333-?O(19 rcquirts ucpacers w�ho reccire tM1e hancncad standarJ �vfuc�ion in veri(y �ha� tM1cy am elicide �o recei.e ihe
benefit and �o pnr�iJe aJdiifoml identifrin_ information �xarvry ro allw� cwnq' �rmmrnt ro betrer moniror Mmesmad
filin��. This in(amuiion .ill be Ae�v eonliAential and wn nnly fk: amsnl br au0nrirN aounry� oflicials. The Ik7unmrni ol
Local Gmcmmrn� Fi�u�rc< �vill me this iniormanon [o creatc tnils tMt �rill h:Ip ahm:v officials eliminate homcACad haud.
808
Darryld F Cederholm
415 W Emerson
PRINCETON IN 47670.1326
I�I��II���I�II��I���III������II„II���I�I�II�����II�I�I�I��I�I
T•rxpaver Nnme Prnpertc Address
Cederholm, Darryld F/Becky G
415 W fimerson ST
1'rinccton IN 47670
State Parcel Number Leeal Descriotion
� 26-12-07-103-000.664-028 079-oo6sa-oo C BROWNLEE ENLG 4 PT
DEVINS ENLG 11 PT
This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
�• �
. O�.�oer I First R1idNe 1 Lazt
�o.rr 1ci �t��k��c� CQ���-ha``�
• �g Addr� (numbcr end ivee[. city, sia�c, and ZIP code) � S¢me as pmpem odd�¢s
Social Securily Number (last 5 di¢irs) Driver's Licenx/5tatt ID 7��unber (last 5 digiLS) Oiher (plence specify in Pan 4 belox�)
�
Spou:c First Middlc 1 Last
8-�. i� G o, �ec���-h4' �v�
Mailine .Address (Numbcr and a-�reet, cii}', staie, and ZIP cair) j� Same as pmpeny add�ess
w
Social Stturitr Number (lan 5 digits) Drivers License/Siate ID Nianbrr (lut 5 digir,) Other (please spccify in Pan � bclow�)
- - - �
Each undersiened certifies, under penalN of perjury, that the above and foregoing information is we and wrtzct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that, by claimin¢ additional homestead deductions
unlawfully, he or she may be liable for back taYes and substantial financial penalties.
Sienaavc Date '1'clephone
� 't�3�11� ($
Spousc Sipu[u�c _ (�� gtc Tcicphone
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