Homestead_ClarkCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R6 / 4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I'
FORM YEAR
Ja-J
MAR 1 4 7nnR,
I (we) v
' certify that on a sl�My of March, 20
(We) occu as our principal place of residence the following described real property for which a Homestead P ' r, 1@@
rf�S6�,01ffirOr�dMTs`4��'reby dalmec
❑ I (We) owned ❑ Are buying under contract
91 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
k,
ONTRACT.-RECORDED —qi: , ry <
- -� lei. e'en +�'a,
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
County // _ . _ . I Toxnship
Parcel number _ //� Legal description aaw /
If any portion of We residential structure or the land not exceeding one (1) acre that ii
of the property utilized to produce income.
(city, town, township)
Is the pro perty in question_
Real property ❑ Mobile Homo (LC. 61.1 -7)
surrounds that structure is used to produce income• describe the use and portion
STANDARDMEDUCTION'ALCOWANCE Try;rkz~y+ ,_ ,,�y"• u >x''�' •"aiR ",i"�`:`3 Y" ,, �-,.4
20_Pay 20_
Lesser of 112 Homestead
Valuation or 535.000 5
Signature of Auditor Date signed
County
Township
County nship
I hereby certify the above statements are We, correct and complete.
Signature of claimant
Address (number and street, city, state, 21P code) U
POe
box I)-7 FPAfJci3 c) rAV q7 &qq
®
'ASSESSOR USE ONLY -'.,� zR.
a ..,... �. �_ r', trs fia.¢ -e: :`' ..' •,a
''TRUE TAX>rj v
s VALUES ..t`
ASSESSEDYALUE
AT 700 %OF,XTVA
HOMESTEAD'S
` ;VALUE
° i NON_-RESIDENTU\L
o r VALUE s
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
w N.
Other land
2
` 01- IM
Total land (line 1 plus line 2)
(3)4
Dwelling
(4).�,
y,
r k li�J'C..i' 41 y-{?
-'ea ,al'fie
l Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
(5)yS�.a'1,
,,.,r
3s- Swwi5+T�� aia.�c
Other improvements
(6)
€`.= Ti:J$- r�i'yv '' •-
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARDMEDUCTION'ALCOWANCE Try;rkz~y+ ,_ ,,�y"• u >x''�' •"aiR ",i"�`:`3 Y" ,, �-,.4
20_Pay 20_
Lesser of 112 Homestead
Valuation or 535.000 5
Signature of Auditor Date signed
•
'UTE FORM 53,1.01:(!-0•11 1REASUJa FORM SIA
...MOWED BY 51,4TE BOARD OF normsTx.!nn Y[r3WBm BY nu:DEPARTMENT(FL(IL'TL GOELVMI%T'NANCEr VI.I-174.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eser for homestead fraud.Ilomestead fraud causes higher lax bills fir all:therefore.
• HEA 1344-2IX09 requires taxpayers who receive the homestead standard deduction to verify that they am eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kepi confidential and can only be accessed by authorized county officials.The Depannent of
Local Government Finance will u+e this information to create tools that will hap county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Clark, Jerry Don
204 S CENTER
Francisco IN 47649
4624
Jerry Don Clark
P O Box 117 State Parcel Number Legal Description
FRANCISCO IN 47649-0117
ItIuIItultllntlnlltlnii liutllint�n t111nt1r t11r� 26-13-20-103-000.362-005 012-00362-00W&M ADD 6
X
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
�ERR� CIA-ak
¶gAdddseidZlPce) -- -- --- —- -- ❑ Same as property address
v ao,' 1 17 cRwwc CO co __rill i 7 q
Spouse First Middle Last
Mailing Address(Number and Street city,state,and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
star
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 eligible 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 1 Signalize Date
PART 4:ADDITIONAL INFORMATION
•n04tl, HAUL MoRT9A16- De ucTioit)