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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION
State Form 5473 (R73 / 12-09)
Prespibed by ihe Departrnent of tncal Govemment Finarxe
FORM
HC10
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INSTRUCTfONS: See ieverse side !or fiLrg insLUCtions.
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I(We) certify that I(we) ocapied as my (our) prindpal
piace of residence or am (are) buying ihe fdlow'vig des�ribed real property fw whirh a Homestead PropeAy Tax Standerd�Ded�qni�ereby daimed
under contrad on ihe date ihis application is filed, (date of filing). I(We):
JC� 1 cu
❑ Am (are) buying under recorded conVect C���
�(are) enti0ed to occupy as a tenent-stockholder of a moperalive housing corporatlon
❑ Have a benefidal interest in Me Wst or ihe right lo ocwpy the property under Uie tertns of e qualified ptbY64EDtes�ui'airGsi�UDITOR•,
❑ Am (ara) the shareholder, partner or memher of the entity �hat owns the property.
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If buying on contraU. Fee Simple ownefs �me
Recortlers office where contrarl is Rcorded Remrd number Page
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Couniy Township Tazing disUitl (�nl: fown. fownshlP)
pameJ numyar Legal tle.uription Is the property in Question:
poperty ❑ AnnuaDy mob0e Mme (IC 61.1-7)
If any portion o/ tha residentlal struclure or the IaM not exccetling one (1) a�re ihat immetliately su that sWCWra is used ro produce ir�come. tlr..aihe ihe use and portan
w uie ryoperty uwtrxd m yoeuce mmme.
a �-zo-is-�y-�c�-� G�a-ooa
... . . : . .
Caunb Township Counry Tawnship
I hereby certiry the above statements are Vue, corred and complete. �^a� of daimant i
Adtlress numba/ eM L dty, state, aM ZIP codej � �� ��� ��
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Land not ex�eeding t(orre) acre immedtatey . e-.;� "�"'y�'S`:�'�" � c"'+ �:
surtoundln resldentiallm rovements. ��) -��°_-�"-.� �.�+ `^`-� �'
.�..,��,t�.., c� `t
othar lana (Z) ,'^-_-�_-.�?z-z�r.�;;:�°_.
rora� ia�d (r�e � aos r� � �3�
��.�.`; �.��-� w_4 '`.�rt,�=; ,
Residentla� improvements or Annua�y �IIin9 (4) �.. �.- .�'�,3`�r. a �.�st;
0.5sessed Mobtle I Manu(acWred Home ��9e �5� ;-`,�;-",=ti`�-�-; '�^ ��� �?=.� �.
Other Improvements (b) r 1��; r t�'`Sf�: ' �
Total improvemert� (lirre 1 Nrough line 6) (7)
Tofal value (line 3 pl`sllne 7) (8)
I hereby certlfy the above fs We, correct, �9"a�� of n5sessor Date sigred (manN. day, yee�
and complete.
Veif�vig adbn - SigreNre of Auditnr �� y9� (�N. �Y• Yee�)
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20 �� pay 20 � Lesser of 60% of the assessed value of the homestead or $45,000
Na1MiMStaMBrJ anr oMerryovision, the sum W the dedud'qrt Provitletl in Ic Gf. f-i2 ro a rtnWe home tASr is S
nof assessed es real property w to e menu/aCUrad home R�ai is rol assessed as reel proparty may+wt exceed
one-hel/ 72) ol Me esSBSSed velue o/fM mo6Je M1omB w men�detlu/ed home.
� of q�y� Date signed (month, dey, yea�
• STAIE FORM,1s IM-r SEMI TRFAAJLER FORM 1IA
• APPROVED BY MATE BOM onrATgAT1`YM PREAIUBm BY nil nEMR e4T('LOCAL CRWttS51F r FINANCE IC YI.I.L'-LI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead suntan'deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than eta for homestead fraud.Ilomesread fraud causes higher tax bills for all:therefore.
HEA 1344-3009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reeehe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filthy.This information will be kept confidential and can only be 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Harris, Howard H/Darlene // // / 5, 5 S 7
694.7
10>S Division
Mackey IN 47654
Ste
3281 (/
Howard H/ Darlene Hams / icy S 7
- 102 S Ditisiun (09‘, .SE c✓ State Parcel Number Legal Description
Mackey IN 47654
26-20-15-204--000.076-002 015-00076-00 PT NE 15 3 9.32 AC
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T h i s 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
H-0OJae— O f} /40..Y✓ t' 5
40Tg Address(number and street,city,state,and ZIP code) I4 Same as property address
6g65 S. 5-}a-T e ✓-0 9 .5 7 )12 4-O et /n) Li 765 y
Spouse First Middle Last
T�a�l erg yet 1V'a •CY lx s
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
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
PART 4:ADDITIONAL INFORMATION