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CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION
State Forth 5473 (RS 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
i(We) A ILAU Y MJ S)�! U ���_ certify that o 1st oLMarch, 20
1 (We) occupied as our principal place of residence the following described real property for which a Homestea���gpgrty T redit tsbareby claimed:
I (We) owned ❑ Are buying under contract UUlIVV COUNTY AUDITOR
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.
iex w ,— VZV a . . .. 'CONTRACT RECORDED .a .rn'"
If buying on contract, Fee Simple owner's name
Remrders office where contract is recorded Record number Page
ROME RTY.OWNED$Y CL'A1MANT IN'0THER'COUNTIES .-;} '? i �js z; i •E'� €, �!�'Z'''*
ION.' ..h:'ges'tJ
County
Tuvnship
T7th&'o� '
(t township)
Par Inum r
Lega a dpdon
' question:
_RESIDENTIAL
asx4 NVACUE4-
al-
Real property El Mobile Homo (I.C. 61.1 -7)
If any portion of the residential structure or the land not a ceeding one (1) acre that im diatelyy..ssunounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. ..�5-
7;
�_',".G}^•?"�'•�?"y;`�
,- & - 13 - a-o - /01- 000. l �/ -00,5
(f)
ROME RTY.OWNED$Y CL'A1MANT IN'0THER'COUNTIES .-;} '? i �js z; i •E'� €, �!�'Z'''*
County nship
County Tornship
hereby certify the above statements are true, correct and complete.
Sig r re of claimant
'd s (number an slfee , city state, ZIP code)
R/
+� s °sue
5 ASSESSOR SE ONLY
Z TRUE TAX �
ASSESSED VALUE
HOMESTEAD` -'
x NONE,- i •
hYv __:
. VALUES <
- AT 100 %OF TTVD
- _ VALUE ` '
_RESIDENTIAL
asx4 NVACUE4-
Land not exceeding 1 (one) acre immediately
�_',".G}^•?"�'•�?"y;`�
surrounding residential improvements.
(f)
Other land
2
Total land (line I plus line 2)
(3)
Dwelling
(4)
(Residential improvements or Annually
Assessed Mobile i Manufactured Home
Garage
(5)
;o
•". " <tl•. UM -
c i
Other improvements
(6)
Yrx.�' mss,
Total improvements (line 4 through line 6)
(7)
Tdal value (fine 3 phis line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
Signature of Auditor
20_Pay 20_
Lesser of 112 Homestead
Valuation or 535.000
•
• 515TE FORM n!n U-/',Pt IPEIAILER WRY 11A
AEFRm'EO BY STATE 9NRD(WMX.TMt'Ta-:MY PRIYATED BY 111E OEPAAhfEYrOF LOCALCM'ERVMrxe FINANCE IC 61.t-2:4.I
Gibson County Auditor
11 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS .
101 N
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standau]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.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
T D benefit and to provide additional identifyine information necessary to allow county government to better monitor homestead
F
tiling.This information will be kept confidential and can only be accessed by authorized county officials.The Depanmmnt of
L•1_ Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
FEB 16 2011 Taxpayer Name Property Address
_ Hicks, David/Brenda •
C'e'p none
8 GIBSON COUNTY AUDITOR
David Hicks
PO Box 4 State Parcel Number Legal Description
FRANCISCO IN 47649-0004
111111111 titlit Ill IllIPlItIlt.1111111111lrl tt lilt tit It tl ttitll 26-13-20-101-000.181-005012-00181-00 SHOP ADD 30/31PT
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
Owner I First Middle /� Last
g Address(number and street,city,state,and ZIP code) ❑ Same as property address
/oc/A e'E/,}f£,as1 Pt,iBDb 41 _
Spouse First Middle Last
BEEduDA �v y c E 1 0105
Mailing Address(Number and street,city,state,and"LIP code) 0 Same as property address
/O4/agenii—gt& kD. BnSG 'i
— — —
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 ignaturc Date '0(6//
•