Homestead_Ayer•^ • CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse,side for filing instructions.
I:tHIIFII;AIIUN 51AItMtNI
_ FORM YEAR
HC10
1
I- (We) - certify that � �oon��� the
1 Vay f rch 191
�(We) occup d as our principal place residence the following described't'dal'��jify-5i�hich a Homestead
Property Tax Credit is hereby claimed: I (We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is lia le for the property taxes on the property and that owns the
property or is buying it under a contract:-
CONTRACT RECORDED
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded Record Number Page .
IJ:L�I, �I:I�l�1�Y�laI�1L�L`
Count Township Taxing Qistrict (City. town, township)
Parcel Number
OOQ00 L Description C� u a
If any portion of the residential structure or land not exceeding one (1) acre that imme ' tely surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township .� "— Count nship
I hereby certify the above statements are true, correct and lure
pefqplete.
d ss (Street. number, city late and ZIP code)
/U.
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other land
Total land - line (1) plus line (2)
-- Residential improvements Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
(1)
1991 Pay 1992
19 —Pay 19—
Lesser of 1/2 Homestead
(2)
Lesser of 112 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or S1,500
(4)
- - -
- -
(5)
(6)
(7)
(8)
1 hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19 —Pay 19—
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Lesser of 112 Homestead
Lesser of 112 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1,500
Valuation or S1,500
Signature of Auditor
I Date Signed
-a1 -9
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SIAM FORM ata•IR't 54/B 1AFAN101 RAW:3-IA
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APPICIWE0
OPERTY�OWNERS 411-2:4
Gibson County Auditor
101 N Main
PRINCETON IN 47670 Individuals and married couples arc limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than flee for homestead fraud.Iomestead fraud causes higher tat bills for all:therefore.
_ HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to rotas/the
benefit and to provide additional identifying. information necessary to allow county government to better monitor homestead
filing`.This information will be Lep.confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tcds that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Ayer, Janet
205 N Center
Francisco IN 47649
4589
Janet Ayer
P 0 Box 258 State Parcel Number Legal Description
FRANCISCO IN 47649-0258
Irirrllu tltllu tlIIlltlIIlluntItltltltlII iu ititlIIintitll 26-13-20-101-000.200-005 012-00200-00 SHOP ADD 27 PT
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
1/4.21 - C et t L /I-`Kr
•ling Address(number and strect,city,state,and ZIP code) 0-Same ns property oddr¢; —— — --. . -- `—-.
Po Bob .759 ret.yMUS&o i 7`&, y-/ 7L2yq
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
n- 37O
tc4,6,33 sry
Spouse � First Middle Last
-«y0 N ev
Mailing Address(Number and street,city,state,and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Sue
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eliuible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date Telephone
91 C (,/'pJls2 5-(o ib ( a )2_) 782 - 33g0
Spouse Signatulf Date Telephone
( )l
PART 4: ADDITIONAL INFORMATION
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