Homestead_Cloin�
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`" CLAIM FOR HOMESTEAD PROPERTY TAX
a, .__ '; STANDARD / SUPPLEMENTAL DEDUCTION
Sta;e Fo�m 5473 (R72 / 6-09)
�° � Prescribetl by Ne Departmerrt af Local Govemment Frefee
INSTRUCTiONS: See raverse side far filing instnutions.
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I (We) `+— �f��A� �ypi as my (our) pri�pai
. place of residence or am (are) buying ihe tollowing desaibed real property for which a Homestead Property Tax Sfandard Dedu��i�reby daimed
�und r eonVaa on Ihe date �his appliplion is filed, (date of filing):
(We) own ❑!vn (are) buying under recarded coniract
❑!vn (are) entitled to occupy as a tenant-stockholder of a cooperetive housing corporation . ',
� Have a beneficial interest in the Wst or the right to occupy the property under the tertns of a qualified personal residence Wst
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Nameot t Inamej , ' '
Saaal Seartiry nmi6ri (
Sodal Senuiry numbel of claimanYS spouse (last frve dgds) Drlvefs lirense / Idenofration / Ofher bey� � Issu6g�
of da'urem's spouse (lesf five d91LS) (/
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116uying rn contraq Fee Simple v.mefs wme
Recorders afi�x where mnVaq is recorded Recoid number Page
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Counry / 7ovmshi7 • 7' ct (�ily, bwn. t ip)
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Pa�cel num6er Legal tlesaipUon Is �he �operty in qualion:
' Real pmpMy � MnwOy assessed modle tame (IC G1.1-n
�tt any ponion W Ne rrsieential swcWre a �he land rwt ezceed4ig are (1) aue that immeEiatey wrtou s �hal strucWre is used W ptoduce i�uome, Eesaiba Ihe use and portion
M Ne O�oPartY utS¢ed ta praduce inmme.
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Counry To.mship Counry - Township
I hereby certiTy ihe above ste[ements are We, cortect and complete. ,/ Slgnaw^of daimant � �
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AGCress (numDeraMSLeet, ciry, state. arNLPtode) �
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surroundlnz reCSlldentia�m'rovementsdiauty (�) d Ie sf. ��r����;����X� �
I w. �le.� li �.� r�.�-� �-�; ��
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Olherlantl �2) ��;n�e Zl✓ ixry7�/#`%��o .
Tofal land (line 1 plusline � (3)
Dweilin '�°� � Y��' Y�
ResldenUal Improvements or Mnually 9 (4) ��"' ���� �.���"���'
Auessetl Mobile I ManuFactured Home Gare e �`����'`= - ����5��3 �'
9 (5� 4C�,�'�'as's'�k.,:..�`�,1*y.:.��3thh�T�.K`
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Other Impmveme�rts (6) ����-ss- �>�: �
Total Improvemen6 (line I Nrough ltne bj (7)
Total vatua (!!ne 3 pha line 7) (8)
I hereby cenify the above is tr�e, corred, Sig�wre ornsussor Da�e signea (n�mm, aay, yea�
and complete.
vaityi�g a�AOn - SignaW�e ot Auditor Date signed (rtronN. CaY. Y��
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20 _ pay 20 _ Lesser of 60% of the assessed value�of ihe homestead or $45,000
NoM�ith518ritlug eny oNer plOVision. the sum o1Ne tleduttions prowtled "m IC 6-f. f-f7 to e rtabDe Mme /haf & $
nat acressed es real propeAy a lo e rrenufaWrad hwne Naf's nof essessed es real property may ro1 exceed _ '
one�haH (12) 01 Ne assr.ssed valueW Ne mobde home or menu/aCUred home.
Signature of NMItw Date sipneE (rtanN. day, ysa�
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SGTE PoRM SJSIfl (YJ /&1� �%f-�SIAFA fOP.NlS1A
♦PPRP'E➢Bl'SIniEBM0.DOfA(YpUYfS,21M PRFYRIBmBYT�OFPARiNE\iOFIMAI.GO\TA\MEYiFIXA\YFIC6I.1-:$-0-0I
Gibson CounTy Auditor � � � � � � � � �
101 N. Main SUeet �ndividuals and married couplcc are limited m one homestead standard deduccion. As the receipt af this d��_uction 6ecomes
Pnnceton, IN 47670 more bencficial, thcrc is mom incenti�c IFun n�cr for homcttcad (2ud. Homestead (reud wuses higAcr tax bills forall; thcrcforc.
- HEA 13M-?009 mquires taxpaysrs who rccci�c thc homenrad standard deducrion ro�rrify tLat they arc eligiblc co rcccivc thc
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benefit and to prrnide additional idrntifying inlormnlion nccessary to allow counry gwemmrni to bencr monrtor homcstcad
filings. This infortna�ion xill M kept confidrncial and can onty�be aaessed by authorized wunry officials.'I'hc Ucparunwt of
I.ocal Gmxmment firmnce will use Ihis infortnation ro cmntc tools chat will Aelp rnunry' ofTicials diminate Irome>twd fraud.
APR 2 7 2011
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GIBSON COUNTY AUDITOR
2446
Taxpaver Name
Cloin, Darvin E Jr/Shannon.
Lowtion Address
411 W GLENDALE
PRINCETON IN 47670
Darvin E Cloin Jr. I II�I�III��III �II�I ull�ll� II ulll �I�III �I �II�II�II�III�II III�I I�ullull�l�lll I� II
411 W Glendale
PRINCETON IN 47670-1221
����I���I�':�I��������I'�'�I��'I'�I�III'I"I�'��I��'�I���II�I���' State Parcel Number Leaal Description
26-12-07-101-000.83&028 /�USHnnrw aoD 4/5
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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.
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Addccss (numbcr and strceL city, statc, and Z[P codc)
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ciry, statc, and 7.IP code)
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undersigned certifies, under penalry of perjury, ihat the above and foregoing information is we and correct and that he or she is eligible to
ve the homestead standard deduction on this property. Each undersigned also undecstands that, by claiming additional homestead deducrions
vfully, he or she may be liable for back taxes and substantial financial penalties.
^LSimanve /l „ �� � Date Telephone � -
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iiPr. I5, 11
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