Homestead_Johnson (14) MATE FORM!!'MIR'/or,. EREASULER FORM 1"1IA
AMOCO)BY WE BOARD Of An SO T,._vn MISCUE=BY fir DEPARTMENT Of LOC AL CAv2RVMrAT FIANCE IC 6-I.IS:1I
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 e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
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HEA 1544-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.ibis information will he Lep.confidential and can only be aececsed by authorized county officials.The Depanment of
Local Government Finance will use this information to create Rills that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
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- - - "-- Jdhnson, David W/JudyM I 3 S: /Arc- -
+ [. nilaen
Princeton IN 47670
3765
David W Johnson .
1223 S Prince State Parcel Number Legal Description
PRINCETON IN 47670-3013
IIIllIIliIIiIItlIIIIIil 11111 IIllIIltlllIllIIIIIIlII 26-12-18-104-001.519-028 01101519-00 SS ADD 21 PT
PART 2:TAXPAYER INFORMATION
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Owner I First Middle Last
1 ikv I b W,i2eal -To h n Soul
eg Address(number and street,city,state,and ZIP code) N Same cis Property oddress __ . ___• __ _ ._. ._
102 23 S . -1)2./"Ice PRINce-‘n , .A✓ y7G7o
Spouse First Middle Last
Siskotl fit AiC - e-7;A4 SoAJ
Mailing Address(Number and street,city,stale,and� code) Same as propene address,14
pan S. Pe_iacc ,e/�ce-- o // 7-47 V7X70
Each undersigned certifies,under penalty of perjury.that the above and foregoing information is live 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 •- liable for back taxes and substantial financial penalties.
Owner I S' acute OF/ Date
I / I
' y I I
IJ
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,
_ CLAIM FOR HOMESTEAD RROPERTY TAX
CREDIT/STANDARD DEDUCTION
t State Form 5473 (R6I403)
' Prescribed by Iha Departmeni o( Local Govemmant Finance
� INSTRUCTIONS: Sea reverse side /or �ling instructions.
FORM
HC10
YEAR
i M'e) I` I' 1 1 r'c�d`t�)�-� c@rvryu�lrc�i�o-�Te�n.2o
I(We) occupied as our principal place o esidence the Ilowing described real property for which a Homestead P� ppeft7r Jm�C�¢,Qj( }S hereby Gaimed:
I(We) amed ❑ Ne bvying under contract
MHT 1 U LUU�
, Have a beneficial interesi in the entity Nat is lieble for the property taxes on the properry and Nat owns ihe prep�y or is p��gng under a conUact.
II byMg on conireq, Fee S4nple ownafs name
Recardefe ofice whare conVaq is racorded
Ca1�ly TavnS�ip
F mber Legal de pti
i�`
(/Li i
If eny portirn o( Me resi0ential sW cNre w Ihe land rwt ezceeding one (7 ) acre thal
d the propaity uWZed [o produce income.
To.vnship
II hereby cerUfy Ihe above sietements are W e, correct and complete.
nss (number end suee4 dry, slata, ZIP ooda)
Racordnumbar �Pape
. _ . _ _ _ . . , . .. _. _ . . ,. � __.. _._. - . . .
� disUict (ciry, town, fownship)
Is tha property N puesUon:
❑ Real property ❑ MoWle Home Q.C. 61J-n
surtounds that sWCture Is used to O�uce inwme. describe 1he usa and poNOn
Coumy
Signature of Geimant
��`�°"�'`r�`�"°�" '��°� `� ��n � ' '� ''ASSESSEDiVALUE --_ liOMESTEAD � {} � 1 t � �'
r
�'=�� K� TRUEiTAXom ,
��;F..� '.ASSESSOR USE�O�NLY4 -�zy�1 ��� . o�� VALUE :^�S`� ,. AT-i10DX OFr1TV� �--� VALUE �:� r a NON,R ASIUENTIqL t
L,:
Lend not exceeding 1(one) eae immediately �.; ? -.,� 1-
surroundingresidentlalimprovamenis. ��) f �;:;. . -
Other land �Z� = _ - _ _
-� .: • '
TUaI leml (I/ne 7 plus line 2) �g�
_y
Dwelling (q) ;;. a .: F} ,{i' '4 , ..
ResldenUallmprovementsorMnually - �:;�.�.y,:,.:,.�;::,.��..�;,�,.,:,,.:_.*� �..: .
Assessed Mobile / ManufaGUred Home ;,w , � -- �.-f s f ; ;
Garage (5) .. - ;:.b
?:>°;:-;_i;� - = .
._. - -
O�qe� improvements ' (5) � � � _
TAaI Improvements (line d through li/re 6) �7�
TUSI value (line 3 phs line � (g�
I hereby certi(y the ebove is We, cortect, end Signamra of nuessor Daro siBned
compiete.
Verilyuip edbn - Signeture aflwditw Date sipned
f�.,.air+� kryi!'i1�r&�:n,�.:.:Yi`t YiX::ci�.L r .a�-::STANDARD'DEDUCTION'ALLOWANCE�. -- -
-' � .. 20 _ Pay 20 _ ,
Lesser of 12 Homestead
� Valuation w 535,000 g
SlpnetureofPr�ditor � � �ateWBne . O^ ` J
1 t�+