Homestead_DonohooCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stata Fortn 5473 (R6 / d-03)
Prescribe0 by ihe Department ol Lacal Govemment Finance
INSTRUCTIONS: See ievarse side /or filing instn�ctions.
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FORM YEAR �
HC10
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��e) certify that on the 1 st day of March, 20_
I(VJe) upied as our principal place of residence the following described real property for which a Homestead Property Tac Credit is hereby daimed:
I(We) owned ❑ Are buying under contract y—� �q{ '�p{��
' Have a benefidal interest in the entity that is liable for the property taxes on lhe property anqp�el o�s 61 �od�rN or bu g under a wnVact.
8 p fl 'b "i
I( buying om m�trad. Fee Simple owners name
Remrtlefs olfica whera wnVaq is recorded
- .'.. I Page ��
County Tavnship Tacing i' ciry, town, fownshi
ber O� Legal description Is e properry in question:
..
' �ro0erty ❑ Mob�e Hamo (/.C. 61.7-n
If any portion ol lhe residentlal sW Gure w Ne land not esceeding one (1) aae Nat immediately surrounds that stiucWre is used to produce income, Cewibe the use antl poNOn
of Ihe property utiGzed to protluce income.
Counly
I hereby certiy the above statements are We, cortect and complete. �
Addreu (numberu�Msfree(, ciry, s(afe, ZlPcnde)
�` '� .� .� /J .i � / . !r n _ �
Land nol exceeding 1(one) acre immediatety
surrounding residential improvements.
Other land
Total land (line 7 plus line 2)
Dwelling
'Residential improvamenb or MnuaUy �
Assessed Mo6ile / Manu(actured Home Garage
Other improvements
Total improvemenis (line 4 through line 6)
Ttial vatue (line 3 phs line n
I hereby certify the above is W e, correct, and
complete.
Verifying action - Signature otlwditor
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Signature ofASSessot
ot
Date signea
Date signed
[IALEfOR]I �!W I�/)+MI 1RfA31111fAPo0.4 iS1A
.1��W�.'NBYai�TEBMPOQ!l'.[A�.\i3.br� ��,fy(RIBmBYiIICDEtA0.MEYf[1flfX'ALCp�:A.`MR.'TiQPn\'CEICLI.1"-1.1
Gibson County Auditor
101NMain '� � � � 1 ••�• • � •
PRINCETON IN 47670 L�dividuals and m�rriN mupin are limittd Io om home.ICaJ �andaN dNunioa As Ne receipt of ihis dedunion bttronree
more beneficfal, therc ie morc incentne than e�er for honxstead fraud. HomnttaJ fmud cauxs higher tar bills (ur all; therefore.
� HEA 13+/-?009 requim u�pa.ers ..�ho rcceive thc hanes�ead sunda�d deduaion in reri(y tMt �hey me clieiMe �o mcei.e the
benefi� an1 to p�m'idc ahiitio�ul idemiiyin_ iniormanun neces-vn� �o allw� counp� ¢memmeni ro W.nrr moniror Iwmatead
tJin��. This in(amuiim xill 6e Aep conlide`uial and ren nnly h attr>snf by autMriml coumr oRcialz. TAe Ihpanmem o(
Lucal Gmrmmeni Fire�rce ���ill u<e this intormation m ercam tuols tlut x'ill hdn camiv offirial. dimiwm homest<ad fmud.
911
Bred Donohoo
430 E Broadway
PRINCETON IN 47670-1844
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Taxoaver IVame Prnpenr Address
Donohoo, Brad/Delanea
430 fi Bmadaav
Princc�on 1\ �7670
State Parcel Number Leeal Descriotion
�'26-12-07-203-003.302-028 Ot�o33o2-00 PT SE 7-2-10 z5 AC
NS LOT 1 PT R7
This form MUST be retumed to County Auditor's office.
Piease do NOT send this form back with your tax payment to the county treasurer.
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Ouver 1 First Middle LaSt
�aNO a
g Address (number and streiv, ciry, smtc, end ZIP code) Same as prapem oddns;
Social Securil} Number (last 5 dieiLS) Driva's LicensdSiate ID Number (Ias1 5 digiB) Other (pleue specify in Pan 4 below')
Spou;e First Middlc lasc
� 1
Mailine Address (t�umber and slreeL ci1}', slalc, and ZD' cqk) I� Same u pmpem addres;
' LYJ
Social Stturin• Numbcr (laz� 5 digits) Drivcrs Licensc/Statc ID Nwnbcr (last 5 dieits) Othcr (plcasc spccify in Pan 4 bcbw)
. . ,
Each undenigned certifies, undzr penalty of perjury�, that the aboae and foregoing information is wz and correct and ihat he or she is eligible to
receive the homestead standard deduction on this property. Fach undersiened al;o unders�ands that, by claimin¢ additional homestead deductions
unlawfully, he or she may be liable for back taxes and substantial financial penalties.
Ox'nn I Signauue Uale 'I'cicphone � � ��
4- �a-ao�o $
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