Homestead_McKannanrt.q
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
'� uu State Form 5473 (R5110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
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I (We) Jt. a k-�) l e Ai� �—i "04 o 0_
I (We) ocoupi as our principal place of resident the following described real property for which a Homestead Property Tax Credit Is fereIy Jaime I
" (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 or is buying under a contract.
c.• cssi7. 3sz...` ta` Y" t�--°'- t�'_'' i`{ y' 9iCONTRACTRECORDED
If buying on contract, Fee Simple owner's name
Remrdefs office where contract is recorded Record number Page
U:itrN 5 � r � .�rh -- Y 4a- i±fi✓ -�i4. .� - hi 11 1I bi �.
- a. ==.._ ' .c. �;�,- r, �'' = �,s- °�i�`- z�n"%�'- `z:�'� -c' -� P,ROPERT,Y•.OESCRIPTION�r,?'s - �s73e: %:�f',1�- "'��- ia���r�-��:
County
Township
Toting district (city, town, township)
Parcel number
Legal description
Is the property in question:
1�[ ^ C n
I
❑ Real property ❑ Mobile Home (I.C. &f.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
'f 0& f'' '1`PROP.ERTY:OVJNEDBYCLAIMIiNT, I1J OTHER "COUNTIES''.; „'f3' :._3i3;c ''^'_+
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature o laimant {'��
1 r \
Address (number and street, city, state, ZIP code)
a►
1d5 "'».
1Y� �bASSES50R USE ONLY .+ r-
E z W
TRUE TAX :
- -
ASSESSED VALUE
�; -
,�eHOMESTEAD •
a .;
��r NON,RESIDENTIAM40
.
VALUE,`,' :
AT3100 %'O T7V
VALUE, �t'
-"r' VALUE;"
_
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
it r �. IMIA
Residential improvements
Garage
(5)
rte_
• �C-'F`
.�4`�'`' -= .;;e.��:
.n?rx
J /
Other improvements
(6)
qMl jam. vas
'Let m`e't]:'}.
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20_Pay 20_
Lesser of 12 Homestead
Valuation or $6,000
Signature of Auditor Date signed
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SLATE lnr4 r3r IR. 1PFASn REA PORN 75-IA
APlfl ED BY RATE M,ROOFMYUFN f.91 M p.rnlam BY THE DEPARTMENT OF LIX'AL rovsrsMENT FINANCE MH.t-r-tl
Gibson County Auditor
01 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 escr 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 creche the
benefit and to provide additional identifying information nemsaty to allow county government to better monitor homestead
filings. This information will be kept confidential and can only he accessed by authorized county officials.The De anment of
Local Government Finance will me this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTYIINFORMATION
. Taspaver Name Property Address
McKannan, Kimberly Ann
RI Box 214 n !
Francisco IN 47649 ^/: Lt.
1712 /I-1pp �'/•[�z
Kimberly Ann McKannan l)Ig-
R1 Box 214 State Parcel Number Legal Description
FRANCISCO IN 47649-9006
1 1 III 1 1 1 1 I I I l I I I III 1 1 26-13-18-403-000.138-005 012-00138-00 PT SE 18 2 9 1.13 AC
t u tot ut u t n t n nt nn n nt t n t u PT NE 1929 — -
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
arr i� �n //a -,/ flail
tg Address(number and street city,state,and ZIP code) I2f Same as property address
j 59 79 ,E SA Z( 4 Y rrav�aseu -TN f/74
`/74
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
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 ignature Date
PART 4:ADDITIONAL INFORMATION 1
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