Homestead_Dickea�—h°E CLAIM FOR HOMESTEAD PROPERTY TAX
i��: CREDIT/STANDARD DEDUCTION
, .�%� Slate Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side torliling instructions.
FORM
HC10
EAR
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� - � C6RTIFIC Tlurva�h�cmcm �
I(We) ceriify that on the 7st day of March, 79_
I(We) upied as our principal place oi residence the foliowing described real property for which a Homestead Property Tax Credit is here6y claimed:
(We) owned ❑ Are buying under conhact
,_, Have a beneficial interest in the entity thai is liable for the property taxes on the property and ihat owns ihe property o�v�ng�nde�nt�
CONTRACT RECORDED
If Wying on contract, Fee Simp�e owner's name
Rerorder's oftice where Contract is retorded
� ' PROPERTY DESCflI � "
, Township � Tauing ist � t(ci , taw township) �
1
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�= O^ ^ �` � egal desuiption
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ot the residential struaure or the land not exceetling one (1) acre that immediatety surmunds that swcture is used to produce income, describe Ne use and portion
y utilized to produce income.
PROPERTY
certify the above siatements are true, correct and complete.
�u�e�ndgtreei. ciy/:.1 AZI�?'t�( �ff'lt-�_
S/ l'
ASSESSOR USE ONLY
Land noi exceeding 7(one) acre immediately
surrounding residential improvements.
Otherland
Total land (line 7 plus line 2�
Dwelling
Residential improvements
Garage
Other improvemenis
Total impmvemems (line 4 th�ough line �
Total value (line 3 p�s line �
I hereby certify the above is Irue, correci, and
complete.
VeriF/ing action - SignaWre of Auditor
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000
BY CLAIMANT IN OTHER COUI
Counry
Signat� e of daimant /
.P�f.G�J d
TRUETAX ASSESSED
VALUE VALUE
(�1
(2)
(3)
(4)
(5)
(6)
n)
(8)
Signamre ot Assessor
STANDARD�DEDUCTION
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HOMESTEAD
VALUE
Tawnship
NON-RESIDENTIAL,
VALUE
Date signed
Date signed
Daye39ne= I � '
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SI.iR fOrt11 �� W IR'/ NYI IRFASII�fA fOAbS1A
n�i1ttT'fOB1ct�1GMHRDOiM[��.'It9n PFFy(AI�mBYllll�[tMi��YifrtLOUlf.[RELVNp.TiP�\'CCIC4I.I.L'J.1
Gibson Caunty Auditor
101 N Main � � ' � � � 1 ' • 1 • • � •
PRINCET�N IN 47670 IndiriJuaL+ anJ �rurriN coupk� arc IimiteJ to nrc hnmc9eaJ �mdanl AcJuninn. A> �he receip� of ihis dedunion beconxs
merc beneficial, �herc i> morc incentne ihan r�<r (or home'�encl fiauJ. Ilome:reacl fnmi ouscs hi�her ta� billi for all; Ihercforr.
� HBA 13+i-?IM19 rcqu"un ua�u�en aha receive ihc hanestead standud JcJuction in v.rity that �hcy are eli;iNe �o mcenc thc
benefit ani ro pnn�ide aAJiiiu�ul iJrntifrin� infortn:nwn ekcrssarv� io allw� coun»� gmrrnment ro bener mwuror IamesteaJ
filfn��.'Ihix infnrmatinn xill M Aryv con[Jemial and r�n nnly F.: acec�ml h�� awharirnl roumy o�litials. 7Te Ikptnnmm nf
Loral Gmemmem Pi�unte will me this intormauon N cream [uols that will h:Ip avunn� uffirials diminarc homesimJ iraud.
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3725
Edward L/ Terri L Dick
1304 Carol Avenue
Princeton IN 47670-2810
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T•rspaver Nente
Dick, Edward L/ Terri L
State Parcel Number
x 26-12-18-103-000.656-028
Prnoem� Addresti
130.1 Caml Avenur
1'rince�on IN 37670
Leflal Descriptian
01300656-00 MCKAW SUM 14 PTI75
PT/16/17118
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Ow'ner I First Middlc l.ut
" w rd L ��C
�g Addm+ (number mid imzt eirv. smte. and ZIP code) --�-- "— � Same ns pmpem oddrcc; -- — - �' ---'
� r C l b'eh ue �in o N�7G 70
Social Sccurily Number (last 5 digiis) Uriver's Licenx/Sta¢ IU Nmnbcr (la.l 5 digiB) Other (pleasc specif in Pan 4 below)
Spou;c Fi=st Middic Lut
Terr� � nh
Mailing Address (Number anJ at¢eL city, slnle, and ZIP cale) �$ame u pmpeny addres�
/3oy Cawol % �e �r'ineeto 7G7o
Social Security �umber (latt 5 digies) Dri��ers LicensdSUte ID Nianber (laa 5 digi6) Other (pleue speciCv in Pan 4 bclow)
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Each undersitmed certifies, under penalty of perjury, [hat the abovz and foregoing informution is we and cortect and that he or she is elieible to
receive the homesiead siandard deduction on this propeny. Each undersicned al;o understands that, by claiming additional homestead deductions
unlawfully, he or she may be liable for back taxes and substantial financial penalties.
O�.�ner I $i�mabve Dsm Telephonc
�.,�.o ,lS ' -27�aoiv �
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