Homestead_Cuzzortj^�a
i � CLAIM FOR HOMESTEAD PROPERTY TAX
���'.E CREDITISTANDARD DEDUCTION
\�� Sta;e Form 5473 (R2l 5-92)
INSTRUCTIONS: See �everse side for liling insrructions.
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I(We) � Q" 1✓ certify that on the ist d�lJLR1�kN1(9'��
�e) occupied as our incipal place of residence the following described re . operty for which a Homestead Property Tax Credit is hereby claimed:
�J�.1 I(We) owned ❑ Are buying under coniract
LJ Have a bene!icial irnerest in the entiry that is liable for the properiy taxes on the property and that owns the property or is buying under a coniract.
CONTRACTRECORDED �
( If buyfng on con,racL Fee Simple owner's name
Recorder's offke where con;ract is recortletl Rewrtl number Page
PROPERTV
Couniy
:ownship)
Parcel number Legal tl Iion
�iq -oa3a� �;� �� I'1-a -lo ,�t, �C.
It any ponion of ;he resitlential stmcmre or ihe lantl not e.ceeding one (t 1 acre�that immed�atety surmunds that stmcmre is usetl to produce income. describe ihe use antl portion
a; ihe pmpeny utilized ro praduce fncome.
PROPERTV OWNED BY CWIMANT IN OTHER COUNTIES �
Counry Township Counry Trnvnship
�eby cer,ify the above statements are true. correct and complete. s�g�a;ure of dafmani rn �
I Atltlress (number and sbee(. ury•. state. ZIP code) �`�� C/
h—� � oZ �c{. �l �i�.�+�.�.2�� Q�. .'i 7(p 7 a
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
ILand not exceeding 7(one) acre immediately I I I I
surmundingresidentialimprovements (�)
Otherland (p) (
iotal land (line i plus line 2� I(3) I I
Dwelling (4) I I
Residential impmvements
Garage (5)
Other impmvemems (6)
Total improvemenis (line 4 through lina � (7) I I
Total value (line 3 p�s line Tj (8) I I
I hereby certffy the above is ime. correci. and I Signa;ure o� nssessor I Da�e signed I
complete.
Veritying action - Signa;ure of Autlimr Daie signetl
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P E O IN 47
OCT 2 9 zutu
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GIBSON COUNTY AUDITOF
SIAiEFOM1Y!JHIILIYNI
11�RP'FD BY c��RlONOOf
tPL SUl[Ai00.V31�
Indi��iduals and ma:rierl toupla are limi�ed to ore home�teaJ &andard ANunion. As ihe rettipt of �his dedurtion hcomes
morc beneficial, thrre i> more mcentnc than e�er lor homrstexl (r�ud Homntead faud causes higher tac bills lor all: ihere;ore.
HEA Il�li-30W requirex u�pa�ers xho receire the hanestead sundard �rluction io .erify thm they are elieible to recei.e tM1e
benefit ani ro p�w�idr ad�iitiuml idrntit�inc informatiun nems�rv ro allou' cwnn� gm'emmml ro bcner mmiror twmesread
filin��. This informaiion will br Arry conTdauial and c�n only h acressnl br autAor'ved rounty officials. The Ikpannuni of
Local Goremmem Finanee � ll me ihis iniormmion W cr<a:e uwb �hat will hcln avuntv officials dimiiurc hnmcs�eaA fiaud.
Terry M/ Deborah L Cuzzort �
R2 Box 49
Princetan IN 47670-8702
�i�u��in�i��n�ni���u��u�i�ni���nin���in��
Taxoarer Name
Cuzzort, Terry M/ Deborah L
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� State Parcel NumAer
I I I 2Cr 12-17-104-002.32�4 Q28
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Propert�� Address
Rz aox ae
Princcton 1\ 47670
Le�al Description .
079-02324-00 PT NW 17-2-10.36 AC
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.
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ow„e. � e�rs, ntiadle Last
/ �`!'h' 1 C�LI -Lt Y`
� Address (number and ivcc[, city, smte, and ZIP code) � Same as pmpem eddlesi
//IS ,C, � S. �` i n � LN 47G7C
Social Security Numba (las[ 5 dieils) Uriver's Licertsd5late ID Number (lasi 5 digiB) Othcr (pleasc sptcify in Part 4 bdow)
Spouu First Middlc Last
I.�zh 'r L.ee CC< z . —
Mailm� Address (Number and svcc4 �q'. state, and "LfP ca3e) � Same as pmpem adJ�ev;
Ii�s- �, o�.;� sr. -r
Social Sauriry Number (last 5 digits) Drivds Licrn�r/Srare ID Nivnber (lazt 5 digits) Othn (plcise specifv in art 4 below�)
$-
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-- E_:h-ar.d^mi���certifies,-und=r-;.enalty�of-peqary, fhacthe.aF�ove.and.foregoing.informatinn.is.m�e.and correct and.that he.or.she.is.elieible.to_
receive the homes�ead standard deduction on this property. Each undersi¢ned al;o undersiands that, by claiming additional homestead deductions
unlawfully, he or she may be liable for back taxes and substantial financial penalties.
Owner 1 Signanue DeL^ 7'elephme
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