HomeMy WebLinkAboutHomestead_FoggCLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
� Stlrte Fwm 5473 (R6 / 1-03�
Prescribed by Ihe Department ol Local Govemmenl Finance
See reverse side Io� ins(ruc(ions.
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NOV 2 9 20�4
� (we) � (.�% �(.� (�� �� vi cer�ll�JA�Q�i�� �f~t�Y'aich.�20_
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I(N/e) oaupied as our principal place of residence lhe following described real property for which a Homestead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Fve buying under contract
� Have a benefidal interest in ihe entity ihat is liabie for the property Wxes on the property and that ovms the property or is buying under a wntraU.
I( buying om m�irad. Fee Simpia ownefs name
conVaq is reoorded
Caunry
Toxnship
Record number � Page
r ce� ce,r��r-�l^/ ' c /1 � I scnption/ 1 9 �y Is the properry i quesGon:
/ —�` J�} l d— i� v ��, C' (� �/ /� �U d �Real pmperty ❑ Mobila Homo Q C 6f 7-7)
H any portion ol Ne residential sW cture w Ne lan ot eaceetling o�e (1) aae Ihat immeEiatety surtounds Ihat Gure is used b produce income, describa Ne use antl partian
of Ne proDerty ulilized to produce income.
S�"x.��,�� s �r5`,h �:s "£s�,��i+'�"�- �. . . . . . �
�¢i SSESSOR�USE HLY�- u�; TRUEeTAX�-�;`�sE ASSESSED VALUE�. `�" HOMESTEADT� � NON-RESI�ENTIAL w_�
�.�. �.�.'ia„�' +�,&L;}q�*!s�'�„�. ,���Hy?,�i ��,VALUE�"ryy� AT 100%OF�TN� �� VALUE� �e��'�� VALUE�'A "*:r'��
Land not exceeding 1(one) ave immediatety r-.°�r`�?��"'�,�" '�':2'�
surrounding residential improvements. (�) '�� �`°� = �'� r;
� s�- E�`�,:,-�-����
Other land (p) f#��� =���X�
:.�e. °�'s.zz�
Tctal land (line 1 plus line 2) �3)
oWeu��s (4J ��' �4 �_��..�`r�;�'"�-; �S
Residentiel improvements or Mnua�y �'4;`""� � y' u""�` k'���
`";^ ���`' ti{�:
4
Assessed Mobile / Manufuc4�red Home Garage 5 � � t t s
( ) �a. * . y r� ��`�
`�+�� i y3� y
Other improvements (6) �'-i ° . -��i =.
-�r L4: �`A ....i'
TUaI improvements (line 4 thmugh line 6) (7)
7ocal value (line 3 plus line � (g)
I hereby terlify the above is We, corted, and SignaNre olASSessor Date signed
complele.
Verifyi�g actbn - SignaNre oflwditor Date signed
'���%�•�",�`���,,,r"-,`-!g�,�}��'����,���STANDARU!DEDUCTION'ALCOWANCE,�:v�,."�'�.:��x�"ay;°� f�i'�' „'""3f.'�`,'��iR�=�
20 _ Pay 20 _
Lesser of 1/Z Homestead
vauanon w 535.000
5
Signaluro o�lwdha � Date signed
Gibson County Auditor
101 N Main
PRINCETON IN 47670
1082
SIAiE fOA.\I!)!MIIL'/ SW I
n��R[T'EfiBYS�V E O��RD W
1RfAS11ALAPoR4Y1.�
IndiviJuals and married aoupks arc limi�ed to nnc home�ea� atandaN JNunion. As �he receipt ol Ni> Jeductian beconxa
morc benencial, thrrc u marc incenme tlun rcer for homntta�l fnud. Homo'rcad frduJ causes higher Iac bi0s tor all; therefw<.
H!A Ii3i-2W9 rcquires uaparers who receive Ihe hpnes[eaJ standard dnluction �u verily that they me elieiNe to rtrene �he
benefit am1 to p�m'ide a�klitional idrntiiyinc in(wm:mm� nemsarv ro allw� cwnry gwrmmrnt ro beettr monitor homnte:Kl
filin�,�. This inlormaiion will Ar Aaryw cmtidemial nnA ran only h: aarecsnl M1y amho�ized mnny� o(ficials. The Ikpanmcnt n(
Local Govcmment Finance xill u.c this infomution m crcate hwls Poa� �rill h:Ip cvwm� offiriaL. <limiwtc lumesmad (rauJ.
.� �� �
Taxna��er Name Prnpem� AJdress
Fogg, Tom W/Paula C Elpers
Tom W�8 Paula C Elpers
707 E Water
PRINCETON IN 47670-2243
I�I��II���I�II��I���III�����I�I��I�I�I��I��II�II���I���II��I�I
707 [ \\'aler S'1'
Princeton IN;7670
State Parcel Number LeQal Description
26-12-07-402-000.815-028 07s-00815-0o LYNCH 1ST 99n0o
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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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Spou;e First Middlc Lazt
Mailin_L' Address (Number and strtt4 ��y, siale, and'LIP code) �$;une as pmpertv addtesa
Social Stturity Number (latt S digiLS) Drivds Licensc/Statc ID Nianbcr (Ia;t 5 digiti) Oeher (plc�sc spccify in Part: bclow�)
s�,.
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Fach undersiLmed certiftes, under penalty of perjury, [hat the abovz and foregoing infortnation is trve and correct and that he or she is eligible to
receive the homesiead
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