Homestead_Sisk (5) t1AME foRY!AR.IRn 0,0 TREASURER FOR.:}IA
APrRcno By STATE BD\RDOE A Ttc5Ie.!5W PRF3T®W BY MR DEPARI'e4T(LIron C.OVELV tnnn FIANCE IC itrl-r-r.l
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sandanl deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ever for homestead fraud.homestead fraud causes higher tat bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will he kept confidential and can only hh accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
ppp PART 1: PROPERTY INFORMATION
,r Taxpayer Name Property Address
• Sisk, Gary L
APR 7 2010 Po Box 315
Princeton IN 47670
382
Gary L Sisk GIBSONrCOUNTY AUDITOR
P O Box 315 State Parcel Number Legal Description
Princeton IN 47670-0315
�t� nuu��1 26-11-12-203-0002.616-028 019-02616-00 BMA 116
D 11nr1r11n1ur111nr11 11n n11l 1rlll11l1r1
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
667Z r_'c., S/ 5 it-
•ng Address(numger end street.city,state,and ZIP code) — — - - — u'Same as pepsin).uddrss - ---
/ y42/ w, 1fi n0n4/-iPA4) - rift/AAA 7641/ f� f';17,0 �? o, iS d 3/i
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as properly address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please spvvify in Part 4 below)
sex
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
•
�a_ ��0
aE � CLAIM FOR HOMESTEAD PROPERTY TAX
i��': CREDITISTANDARD DEDUCTION
�� State Form 5473 (R2 / 5-92)
���u�
� INSTRUCTIONS: See reverse sidejo�i.ng insY tions.
CERTIFICATION STATEMENT
FORM YEAR
�HC10 d�S
)�' �
JUN 13 '9q`
"e) " certity thaTon ihe 7st�day o(���AaicFi. 7��
HVVi � Vn
a� occupied as wr princ I place of sitle e the following described real property for which a Homestead Property Tax Credit �s hereby daimed:
❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in �he entiry that is liable for ihe properry taxes on the properiy and that owns the propeny or is buying under a coMract.
. CONTRACT RECORDED
I: buying on convaa. Fee Simple owner's name
Recorder's o@�ce where mntran is recorded Record number Page
Coumy
Partel
Township
Legal tlescrip�ion
I: any ponion ol ;he resitlential stmcwre or ihe land not e.ceeding
ot the propeny milized to produce Income.
PROPERTY DESCRIPTION
Ta.ing district (City. mwn.:ownshlp)
LLJ—L/ �
) acre thai immetllatety surrountls that s:mcture is usetl to protluce income, tlescnbe ihe use and portion �
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Counry Township Counry Township
�reby certity the abo've statements are true. correct and complete. I Signature ol cl,' ^
L
I Address (number and sbeet. city. state. ZIP cotle)
i !Y� / �✓ �f d v.r�►i=�.,:G� �
ASSESSOR USE ONLV TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 1�one) acre immediately
surroundingresidentialimprovemen;s. (�)
Otherland (2) I
Total land (line 7 plus line7� (g) I I I I
Dwelling (a) I
Residential improvements
Garage j5�
Other improvements (6) I
Total improvemenis (line 4 lhrough line 6j I(�) I ( I I
Total value Qlne 3 pUS line 7� (8) I I
II hereby certify the above is true. correct. and Slgnawre oi Asseswr I Da�e signed
complete.
Wing action - SignaNre ot Autlitor Date signetl I
�.
19_Pay79_
Lesser of t/2 Homeslead
Valuation or 52.000
�
�ARD DEDUCTION ALLOWANCE
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