Homestead_Debord (7)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
SteM Form 5473 (RG / 4-03)
Presalbed by ttro Deparhrnrrt of Lxal Govemment FinarKe
MSTRUCTIONS: See iewrsa afda b li6p iubuctip�a
f�v�
FORM YEAR
HC10
��e) � certify that on� 1st da�o�f March, 20
I(We) occupied as our principal place oi residence the foll 'ng descnbed real pmperty for which a Homestead Property T�c�ied�lt fsU�reby daimed:
❑ I(We) owned ❑!ve buying under contract GIBSON C UNTY AUDITOR
' Have a benefidal interest in ihe entity ihat is liable for the property taxes on ihe property and that owns ihe property or is buying under a conVact.
If buyiny on conira�2, Fee Simple owners name
Recordefs olfica where conVad
ot Ihe property
County
Tavnship
land
Tavnship
one (7) aCfe
I hereby certi(y the above statements are We, correct and complete.
and aLeet, dry, stafe, ZIP code)
disirict
wrtounds that
%
Record number
Page
�al D�openy ❑ Mobile Homo (I.C. 67. f-7)
is used to produce inmme, tlesaibe Ihe use and portion
y"t� J��+ A S.SOR`USE ON Y? �- ����TRUEoTAX�� ASSESSED VALUE �HOtdESTEADr�' `� NON-RESfUENTIAL�'�i
���;����;:a� �yy.ys;:gx�.�?�g���{� �VALUE�°6'z,.,�'.'_AT�700%OF�TN� ����VALUE� mh�g� "}a'."VALUE�'--�.i�'�'' ='�E`
�.�., _�.�.Rr:�'��
Land not exceeding 1(one) aae immediately ' �P��, �,-�+;f.3�'P"r��i' �. �r?
surtounding residential improvemenLS. ( � � a'�+� .4'�fS'...�i,��[�'�`�,.,.'� i � s�:
Other land (2) ������ 4� �
� V.�''.;��,"!;'?�? �i
Tdal land (line 1 plus line 2) �3)
:� � N. `,� �g",_�'`�`�--"+�i
Dweliing (4) }r�: �� 'q�'��4Iv<.�'KU�
Residential improvements or MnuaOy �'�'.;'''�-� "�K-" �"x"�'
Asa�sed �bbBe / Manufachued Home (� '.w v?�-"r �
9 5 ''�• ��� �
Gara e ��?�'t.ij�w}�....� . `.�t•��,,`��!
.�� �',�'�+''�
Other improvements (6) � � ; }�g ��
Total improvements (line 4 through line 6) (�) �
Tdal value (line 3 pl's line n (8�
I hereby certi(y �he above is We, corted, and Signan�re W Assessor Date signed
complete.
Veiilying aclbn - Signature af Audimr Date signed
20_Pay20_
Lesser d 1/2 Homesread
vauanm a 535.000
5
�a1-o
�
Gibson County Auditor
101 N Main
PRINCETON IN 47670
SUiE fOA\I!J W 12 /f✓il
rn&uuuxwrtV :�i�
PA[SA(BmpY T�E OEPARMEY�(f LIXALCA�'cR.�'MfT'i IY:A\'CE IC LI.1-LA 1
fndividuaLc md m�rriN coupks are IimitM �o ore homc�tnd �andaN JNunion. As �he roccip[ oi ihis deductan baromcs
mo¢ beneficial, there is morc i�rcmme dun erer for homesiead fraud IlameAead frzud causes hi�ter �ac bills (or all: therefare.
HEA 13a-t-?(N19 requim uxpa�en who ra-ceire ihe hancstcaJ sundarJ JNuction �o vcri(y �M� �Ley are eliciblc to reaene �hc
benefi� aN to plrn�ide a�kliiional identiiyinc intwmation nemvn� tu allw' counn� gm�emmrnl ro Ncmr moniror homesaxl
fili��.'Ihis in(ormalion will be Aepi emlidenlial mA nn nnl}' 6e acett�ed F� aulhorivrJ rnunlc o(ficial�.'Ihr Ikpannrcm o(
l.oral Gwermnrnt fi�uM'< will u.e this iniorma[ion m arum twls �hat will hdn muniv offi�ialz dimiium hrnneztead &aud.
672
Kenneth E Debord
1702 Martin Lane
PRINCETON IN 476703303
�i�n��ui����n�ni���inu��u���i��nin��i��uui�i�i���i�
Taapa��er M1nme Prooem� Address
Debord, Kenneth E/Jane A
1702 DfARTI\ I.N
Princeton 1� a7670
State Parcel NumAer Leeal Descriotion
k 26-�Z-06-203-003.954-028 SWALLOWFIELD #2 TRACT 11
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.
�
oua�r � e�m m;am� ��
[N�IE7Ll �U.GEn1E �P �ofZu
�¢ Addmss (number and itrceL ciN, state, and ZIP codc) �Same ai pmpcm addl¢.
l7oa �)�RT�nJ LnN� �,e�tic.Ero,J /nJ 4����a
Social Securily Number (Fast 5 digiLS) lhivers Littnse/S1ate IU Number (lut 5 digils) O�her (ple�ce specify in Pan 4 6elow)
Spouu First Middic La4
.JF�NC ANAJ '—�E �JPliD
Mailine Add� (Number anJ 9ree4 ci�)', stale, and ZIP code) �$ame �u p�openy addrcss
��oa M�ar,� L�.tiE PQ�,�c�o,� l,� � a
Social5aurity Number (last 5 digits) Drivers Licensd5tate ID Nvmber Qast 5 digies) OtM1er (please speciCy in Pan 3 Mow�
— --- �
Fach undersiEmed certifies, under penalry o( pequq�, that [he above and foregoing infortnation is true and correct and that he or she is elieible to
receive the homes�ead standard deduciion on this property. Each undersiened al>o understands that, by claiming additional homestead deductions
unlawfully, he or she may be liable for back taees and substanbal financial penalties.
O�.an 1 Si apve Date 1'cl<phone
� �! ��;%�� 4-q- �� (
Spou;e5iguture �ic Tclephone
Q. .' � N/9/aoio �
.�� � � �