Homestead_DebordCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� Stete Form 5473 (R6 / 4-03)
PrescriDed by the Department o1 Lxal Gwemmeni Finance
INSTRUCTIONS: See reverse side lor filing instnxtions.
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JAN 2 5 2007
� �e� � certify tha���tj@djf'b�XA�?����
I(We) occupied as our principal place of re �dence �he following described real property (or which a Homestead Property Tac Credit is hereby daimed:
[`fi I(We) owned ❑ Are buying under contract
, Have a benefidal interest in the entiry ihat is liable (or the property taxes on Ihe property and that owns the property or is buying under a wntract.
If buy'uig on conVad, Fee Simple owners name
wnVacl is recorded
County � - . � Tavnship
Tacing dislrict �%y, town,
Record number � Page
Parcel number I Legal descriptlon I Is the property in Question:
o� 9 0 3 � 0 3 0 0 �� ae� v�overoi ❑�aia Homo li.c. s�. �-n
tl any ponion of the residenllal structura w the land not mcaetling ane (t ) ace that immediatety surtounds ihat swcwre is used to produca income. desttibe the use and ponion
ol the property uliiize�d/t�p/y�duce i�ome.
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-/o? -fI %-
Tavnship
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I hereby certiy the above statements are true, conect and complete.
County
� s(number arM sbee(, cdy, stafe, ZIP code) � ` " � I
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STAiE FOR\15J5� (0.'JB-09) 'fREASURFR FOMI TSIAI
APPROLFD Bl' STAiE BOARD OF ACCWII�TS.2009 PRF.SCRIBFD BY iHE DFP.VtTA�.Yf OF LOCAL GO�'FR�'�¢.`t� FIT.NCE IC61.1-2?-8.1
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Indi��iduals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneTicial, there is more iucentive than ever for homestead fraud. Homestead fraud
auses hig6er tas bills for all; therefore, HEA 1344-2099 requires tazpayers �r�ho recei��e the homestead
s andard deduction to ��erif}� that they� are eligible to recei��e the benefit and to pro��ide additional ideutifying
information necessary� to allo�v county government to better mooitor homestead filiugs. This information
�vill be kept confidential and can ooly be accessed by authorized county officials. The Department of Local
Governmeot Fioauce �rill use this information to create tools that will help county ofticials eliminate
homestead fraud.
Taxoa•er \ame
)ill Debord
Comp(ete and return to:
ir,� I
,
Procem Address
320 W Walnut
Princeton IN 47670
,L,^}UL�
Sbm Parcel �umber
x 26-12-07•101-003.103-025
GIBSON COUNTY AUDITOR, !01 N MAIN PRINCETON IN 47670
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�da� sea,ay M.nEOr (�ss� s efgits)
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MidNa la5l
❑ SemB as poperty aCGess
$a�l $eaa¢y NunEm (last 5 tliyts) Drirefs L'xense State ID NianEer (last 5 tlI9Ib) sme p�,� (p�ye sp¢r,yy in Part 4 Debx)
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5:h ,_r_ .i .+ ,x - . • w ._i.?,�, :..
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Each undersi9ned certifies, under penalty of peryury, that the above and foregoing in(ormation is true and corred and that he or she is eligible to receive I
homestead standard deduc[ion on this property. Each undersigned also understands that, by daiming additional homestead deductions unlawfulty, he or
she may be liable for back taues and substantial financial penalties.
i s� � � °�e / � rak°r°"°
S/3/ 7�/ o
MAY 3 2010
GIBSON
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