Homestead_WillisCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
n-� FORM YEAR
V HC10
I (we) _L �l x(�� ' J I t.�C.i.C/a+ certify that on the Ist day of March, 20
I (we) occupied as our principal place of residence the following described real property for which a Homestead Property Talgi Credit is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract v "
G! OON C-'' , t.ITC -- .
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.
O_N_ TRACT. .-RECORDEDT'
If buying on contract, Fee Supple owners name
Recorders office where contract is recorded Record number Page
P,ROP,ERT,Y.DESCRIP,TION�
County
Township
County Township
Taring district (city, town, township)
Parcel he� �'
L de 'PG
�, Ci I the Pope C1 Real property ❑ Mobile Home (LC- 6f.1 -7)
If any portion of the residential structure a the nd not exceeding one
(1) acre that immedi�ateety surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
Ja-4 , , , a ', "-' "' ' zz `�`)'
°e? USE ONLYs
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature f clai nt
' re (number sires(, city, state, ZIP code)
"SCa
6
Ja-4 , , , a ', "-' "' ' zz `�`)'
°e? USE ONLYs
- `'"TRUE TAX "t
*�',j,VALUE`'
ASSESSED VALUE
ya HOMESTEADD'w
.,, Vt
�-
,��ASSE�SSOR
z:
aAT., 100 %OFjTfVY
VALUE4,,
yxd -Qr. yVALUE#, L`y
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Mir
-v -ac'-
Residential Improvements or Annually
^isal c`r:.
•`""�- '''£"'
Assessed Mobile I Manufactured Houle
Garage
ee
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
hereby certify the above is We, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20_Pay 20_
Lesser of 1t2 Homestead
Valuation or S36.000
Signature of Auditor
S
AIMEFURMbnNn1Rrtw, MEASURER FOAM"CAM
AMA WED
IMPORTANT NOTICE TO HOMESTEADFPROPERTY GOVERNMENT
OWNERS '
Gibson County Auditor
101 N Main
PRINCETON IN 47670 Individuals and married couple,are limited to our homesead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than exer for homestead fraud.Ilomestead fraud causes higher tax bills for all:therefore.
HEA 1344-?ooc requires taxpayers who receive the homestead standard deduction to verity that they arc eligible to recehe the
•. benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filiniv.Bus information will be kepi confidential and can only be accessed by authorized county officials.The Ikpanmem of
Local Goverment Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Willis. Todd A
RI Box 147A 1
Francisco IN 47649 (((((1 1 t
4448 l�
Todd A Willis
421 N Division St State Parcel Number Legal Description
FRANCISCO IN 47649-9285
�r�rt��rrt�F��rr r�rr��r�r r�F�rrrr�r��rr�rr�r�trt�r�t tt��t t��t� 26-13-18-404-0Q0.065-005 DD1 -00065-00 PT SE 1 8-2-9.216 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
-t di "_-) /Ow 01; 6
-_— tg Address(number and street,city,state,and ZIP code) - -� -- - u-Same US property addrrs— — - - - —-
I.I/ Ali g; u /!idiom ft reg,0euc0 zdJ g74w9
Spouse First Middle Last
Mailing Address(Number and street city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Drivers 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 eliuible 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.
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Owner I Signature .. Date
( /
PART 4:ADDITIONAL INFORMATION
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