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CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R5110-01) , I
Prescribed by the Department of Local Govemmwt Finance
INSTRUCTIONS: See reverse side for filing instructions.
YEAR
ON f I IF X/ I N. A AA-4 N Crs�l I ASX-D6 certify fttjQqhe 1 st day of March. 20
!Lpocupied as Z principal place of residence the f&g described real property for which a Homestead PJCpj:qy -r!6%reclit is hereby datmed:
l(We)owned El Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property orOqyyiQg under a contract.
uTRAcr.RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
A
County mship
Tadn n z ct ( ty. "
to, township)
I �
I hereby certify the above statements are true, correct and complete.
Leg W ription
161.4-1
IJ a the property in question:
4 S Q4- ❑ Real property ❑ Mobile HMO O.C. 61.1 -7)
If any portion of the residential stnrcWre w the not nw exceeding we (1) acre that ifnmddiatety
sbmounds that structure Is used to produce Income, describe the use and portion
of the property utilized to produce income.
'ASSESSED.VALUE
�AT�1100%'OF TV
cza — 13 -/ 9- rl�
kOPEFft;,WbWNl EtFBV!CXLAJ mAfa, IWOTA
County
'.Lul y ownshi
I hereby certify the above statements are true, correct and complete.
Signa
Irs"
" re her and treat, city, state, ZIP code)
I � My-
VALbt& L
W----WN'5z
'ASSESSED.VALUE
�AT�1100%'OF TV
it HOMES
WE
NOI �4 rESilOEWrtA
Land If not exceeding 1 (one) acre immediately
surrounding urrounding residential improvements.
(1)
Other land
(2)
W 1010
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
-
CIR—Uv BS '01—
S N11 W
Garage
(5)
ME
Other improvements
(6)
Trial improvements (line 4 through line 6)
(7)
Total value (fine 3 phis line 7)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature ofAuditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Valuagon or $6,000
Signature of Auditor D ign
I 111aw Uj tqVj A Wiji—y— 1 6� - e:� -3 — 0 3
MATE fOR51'itSIR2r 4N1 TRFAStiIER FOAM i}IA
ArIR('ED BY STAY WARD Orgntl]:"f5.2 4 PAAYRIBW BY TnF DFPARMENT Of REAL rA)rLYNrKT FIANCE M 4Et_'4.1
Gibson County Auditor
101 N Main RI PORTANT 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 mgr for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
105 — HEA 1344-2(x19 requires taxpayers who recen t the homestead standard deduction to verify that they are eligible to receive the
S2.45-
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
fling.This information will be kept confidential and can only he accessed by authorized county officials.The Depannrent of
Local Government Finance will use this information to cream tools that will help county officials eliminate homestead (laud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Doerner, Carmen L(Terry L •
rota. j.cA CSFAd c& t xcx9vlA't
Frei nc.rcd 7-4/
4529
719Y
Carmen L Doerner
PO Box 83 State Parcel Number Legal Description
Francisco IN 47649-0083
I1 III I I I I: I I I I I I III I III I I_ 26-13-19-202-000.226-005 012-00226-00 OLD PLAN 63PT/64PT/65PT
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
_ -e rr•j Lee Oseri€r -
1111,g Address(number aria street.city,state,and ZIP code) - - El-Same as property address - •
r.
n a
o. god/ ?3 ( 4n Cr SCOT 14/ �/7� y 9
Spouse First Middle Last
Cgrm.e41 /-°a Dn er n er-
Mailing Address(Number and street,city.state.and ZIP code) ❑ Same as property addess• 1
P
fl �tane, co, 4741y9
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 I Signature Date
)
PART 4: ADDITIONAL INFORMATION
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