Homestead_Priestly (7) ltAME FORM•l.WIE/vW1 IRFASUREAnMV g1A
APPROvEOBY<tATLWARVormultoac' , RLFYWBm BY'IDFnEPARTHENT FLrRTLGOVERNMIFTrn:.ANCEMHLL4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and ma-ried couples are limited to one homenead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than e'er for homestead fraud.Itomesread 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 reecho the
benefit and to provide additional identifvmc information necessary to allow county government to better monitor homestead
tiling'.Ibis information will be Let confidential and can only be accessed by authorized county officials.The Depannmt of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Priestly, Kevin D/Wilkemina
510 W Glendale
Princeton IN 47670
1324
Kevin D/Wilkemina Priestly
510 W Glendale State Parcel Number Legal Description
Princeton IN 47670-1223
26-11-01-404-002.761-028 01902761-0OPARKVIEW 12/45/46BLK3
t o II raiIl II n I t III II n I t I i.I t I n II nn IIII t I rat II
PART 2:TAXPAYER INFORMATION
Owner I ra Fi rst /�/J Middle G1/�(� -1 Last
diess(munbeTen street,ntv.sate,and ZIP code)— -' — _ _ ____ - —O Sume as ptopeny td&7..s — — — —
•S %' 4rX,C9� s7 ",EZ�' ym.✓
Spouse First Middle Last
ZdX/X(r4x vI SXe7/�y
Mailing Address(Number and street,city,state,and ZIP code) • Same as property address
3/0 tr/, j 371 e (X sr J,ez%c.10ti �22U 1/7670
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 e� `���� Date
IP
i�'��°� CLAIM FOR HOMESTEAD PROPERTY TAX
;,��� CREDIT/ST�NDARD DEDUCTION .
,�,;'� State Porm 5473 (R2 / 5-92)
'�rr
ieu
INSTRUCTIONS: See reverse side lor filing instructions.
' FORM-
Hcio
YEAR
� _ „.,�y�
I(We) r 1 P,5 e\ _Q_L/ J,U i /�JI Pn� cert that on the � st da ot March. � 9_
i FF
�_.) qccupied as our principal place of residence the following described real property for which a Homesi2e Pr�pe�ir_ y%��gredit is hereby Gaimed:
!/ '
J I(We) owned ❑. Are buying under coniract , _ , �
❑ Have a beneficial inierest in ihe entiry ihat is liable for the propeAy taxes on the property and tha%owns the-prope��or is bu g �yfper a contract.
I=` .... - `::Il:,J l/
CONTRACTRECORDED
tl buying on comract. Fee Simple owner's name
Recordefs oflice where contract is recorded
. "� PROPEFiTY DESCRIPTION
County Township " ' Tazing s iy( -, town,.fownship) :
number
Parcel number Legal de cr' tion
0�9-oa7�l=c� � a
If any portion of the residential structure or the land not eaceeding one (7) acre that immediatety surrounds that structure is used to produce income, tlescnbe Ne use and ponion
of the property utilized to produce income. , _
.�
�
' � PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
Gounry � Township � Counry Township
eby certify the above statements are tme, correci and complete. Synamre o� daiman�
�
Address (number aM street, ciry, stafe, ZIP cotle)
ASSESSOR USE ONLV -
Land not exceeding 1(one) acre immediately
surrounding residential improvements.
Other land
Total land (line 7 p/us line 2�
Dwelling
Residential improvemenis
Garage
Other improvements
Total improvements (line 4 through lina �
Total value (line 3 p�s line �
I hereby certify the above is ime, correct, and
complete.
Verifyifg aaion - Signature ot Audiror
� _
TRUETAX I, ASSESSED
VALUE VALUE
(�)
(2)
(3)
(4) .
(5)
(6)
I�I
(8)
Signature ofAssessor
HOMESTEAD NON-RESIDENTIAL
VAIUE VALUE �
Date signed
Date signetl
. STANDARD DEDUCTION ALLOWANCE � -
19_Pay79_
Lesser of tl2 Homesiead
Valuation or �2,000 S
Sgnawr o utlltor �� Dare sgnetl
Q�\
._. .� E. srq �. . ._ .
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