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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / 592)
FORM
HC10
YEAR
�� INSTRUCTIONS: See reverse side lor (ling instructions. `' '�� `�
� CERTIFICATION STATEMENT
I(VJe) Certify Ihat dl M� 1�VU3y dRo�Ch, 19_
I(We) occupied as our principal place of residence the follovring described real property for which a Homestead Property Tau Credit is}{�}eby claime .
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❑ I (VJe) owned ❑ Are btrying under contract � . - �,�,; � %.` �
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❑ Have a beneficial interest in the entiry that is liable for the properry taxes on the property and that owns the pr p�d�P6�i��bU�i�q'dnBe�lQbidi�t.
� CONTRACTRECORDED
It buying on conVaq, Fee Simple ownefs name ��
Recortlefs office where con[ract is recorded � Record number Page
PROPERTY DESCRIPTION - �
Coun Tamship Taxing district ("ty, wn, f wnship)
Parcel number Legal description
o � --cx�3 i�-� p��t.
If any portion ot Ne residential structure or the land not exceetling one (1) acre thai imm�atey su o ds that struaure is used to Oroduce income, describe ihe use antl portion ot
the property utilizetl ta produce inCOme.
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Gounry Township Counry Township
Signature of Gaim�
=reby certify the above statements are true, correct and complete.
Addreu (numberarMStreeL ciry, stafe, Z1P e) �
�O l I I � �'-�Ave ' �� � ��e �o� �►U �/7� 7(�
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
. VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatety (��
surrounding residential improvements.
Other land (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Resideniial improvements
Garage (5) '
Other imprmements (6)
Total improvements Qine 4 through line 6J (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is Irue, cortect, and Signawre of Assesor Dace signed
complete. `
Verifying attion - SgnaWre oi Auditor Date signetl
STANDARD DEDUCTON ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead 5
luation or S2,000
Sig utlitw Date sign
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�Gibson County Auditor
101 N Main
PRINCETON IN 47670
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1527
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tRlASURFAfUkN:9-1�
Individuals and ina:riN muplc are IimitN to one homeuead azndaN JNuaion. As the receipi oi Ihis dtduclion Aecrn�es
ma+rc benendal. tMe u morc incentnr dun ner (or M1omesteaJ fiauJ. Ilomn�rsJ fraud causes hi�M ta� bills for all: therefae.
HEA 13+3-?IM19 requim uxpa.en who �eceive tAe hanesteaJ sundard dnlunion to aeri(y �hat ihey 5rt clieiMe w mcewe tM1e
benefii amt ro pn»�iJe �uklitional idrntiirinc mtumi:nwn �ce.swn to allw� caunn gu.emmmt ro beuer mmiror homes�eaJ
hli�,�.'Ihis infnrmation will M Aryu rrnlidemial and can nnly h armluvl bc w�Mriied rnnmy o�T¢i:ds.'Ihe Ik�unmem nf
Local Gm<mmrn� Pimnce �.ill m< �his inio�mation to crcatt [wl> tlu� �vill h:Ip county afficiaL. <limina�e hom<>�ead (raud.
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Taxparer Neme Prnperh� Address
Fox, William / Sue
William / Sue Fox
111 N 2nd AVE
Princeton IN 47670.1005
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III �?ndAVL
Princeton IN 47670
State Parcel Number Leeal Descriptian
26-11-12-104-000.39Fi028 Ot&00396-00 TOWER HGTS 69
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Ouner 1 First Middl< -/ Last
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�e Addrtv (mimber end s�rtY�, ci�y. suce: and Zf P cede) — — ... . - ' me u prepeM ai'w.-�: - ._. --' —'
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Spou;e First Middle Lut
MailinC Address (Number and 51rce4 cily, siale, and "LIP cu�k) � Same:ti pmpeny ad�Le.si
Social Sccuriry Numbcr (last 5 digits) DmxYs Liccnsd5la[c ID Numbcr (1�ut 5 digits) Oihcr (plcasc spccify in Pan 4 Mlow)
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Fach undersiened certifies, under penalry o( perjury�, that the abo��e and foregoing information is we and cottect and that he or she is elieible to
receive �he homesiead standard deduction on this property. Each undersi¢ned al>o understands that, by claiming additional homestead deductions
unlawfully, he or she may be liable for back taxes and substanoal financial penalties.
Oxner 1 Signtnnc Uatc
Spouse5ipamre pz�e Telephone
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