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CLAIM FOR HOMESTEAD PROPERTY 7AX
STANDARD/SUPPLEMENTALDEDUCTION
State Form 5473 (Rt3 / 12-09)
Presaibed by Ihe Departmafrt of Lacel Govemment Finarxe
INSTRUCTIONS: See ieverse slde !or fiGig instrudrons.
FORM
HC10
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� M'e) certiry mat ) ed ( r) ndpa�
piace of riesidence or am (are) buying the fdlovnng described real property for whid� a Homestead Properry Tax nda '� imed
urder mntract on �he date this applintion is filed, (dafe ol filing). I(We):
❑ Own ❑ Am (are) huying under recorded conVacl �� i 1 2��2
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporaUon C.�.�
❑ Have a benefidal mterest in the trust or the right to ocwpy tlie property under ihe tertns of e qualified personal residence Ws1 '.
❑ Am (are) the shareholder, partner or member of the entlry that owns tha property. GIBSON COUNTY AUDITOR
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If buying on contratt Fee Simple ownefs �me �
Recardeh oRxe wfiere oonvart is remrded . Remrd nwnhPi Pa9e
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Counry iwins�ip 7arim�m di� (ciry; to�m, rownship) -- _.
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Pamel num6er Legal Eesaiptbn 7, . f} � is tha P�PaM in 9uestion: �-�� �
P% SGJ S G�.% / 1— r�i w�ceny � r��ny �uea �noa r� ��c s�. �-n
If any ponion of dre rasidenUal structure or Ure larid not e:ceeding one (1) aae Nat immetliatey sumounds that struCUra is used to.pmduce inwme. Oescribe �he use aM portion
o� Ihe property util'¢ed to protlum Inmme. . .
a(o_i3 /7. 303_000,0�� _�os
-.• . .: . .
Counry Townshlp Counh Township � .
I hereby certiy the above statemenLS are We, correct and complete. '� � of aaimant
Adtlress (numbereM sneeL dfy; sfate, aM IP ooda) �
b�, � o a 8� F 5l� � 4� �o
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Land not exceedin 1 one aere Immedlate . � � �`=-^-�'' �'�"v`��" 's -�"`
surtoundln resldenUal Im) rovements. y �1) �� K—� �' � ==�''�'�4 ����
' t -�4.4e_ � '"
Other land (2) � �, r'� : a '''�`
7ofe1 land (line 1 plus Me 1) . '-(3)
Dvre���n9 (<) 3 '.,�`''� '��F'>T . _�"?s�r�°K� ��-'��
Reside'rtiallmprovemenlsorMnually .. ;�'�-""
ASSesaed Mobfle / Manufaetlired Homa Ga� e 'r� ;;t L`s-� r-. ;�$„-��`"�"'� *-
9 i5) �,� - ye -�='<;:z
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Otherimprovemenb (6) t' . . - �,/,�.�
Total improvemerMS (li�re I through Iine � (7)
Total value (Ilne J pl`s Ilne 7) (8)
I he+eby certify the a6ove Is We, correct, �18°"p ofASSessor Date s18�d (month. tlaY.Y�A
and complete. �
Vaifying adbn - S5re��e of Auditor Dale si9�d (month. daY. Y��)
� . - � � � • �
20 _ pay 20 Lesser of 60% of the essessed value of ihe hwnestead a E45,000
� NolwiMStend4g any offrerprovisbn. Me wm o/ Ne detluc7i0rts prmAdetl in IC &7.7-12 fo a nubde hana Nat is $
not essesmd es reel property d ro e menWaUUred home Nat is rat essessed es real proparty mey not exceed
ma�hatl 721 W Ne assessad s�lue o(Ure rt�oWle Aorne or manWaWred homa.
� . Sigf.9hire Auditar Date signed (month. CaY. )ea�
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olio FORM ,R./WO TREMBLER FOAM IS-IA
ArrRO.'ED BY BRIE MARDI*VTTAINS.!a.r MFYWnm BY THE DEPARTME4T F IEst CAVERNMENt FINANCE MHb3 2-AI
Gibson County Auditor
101 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 tier for homestead fraud-Homestead fraud causes higher tat bills for all;therefore.
• HEA 1344-2009 requites taxpayers who remise the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.this information will be kept confidential and can only h,accessed by authorized county The Ikpannent 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
Dixon, Kenneth 110< E ooc\
tOEMIL-
Francisco IN 47649
4420
Kenneth Dixon
FRANCISCO IN 47649-0319 State Parcel Number Legal Description
Irlrrllrrrlrllrrrirrlllltrll Ilttttllltl Illtlttlrttll 26-13-17-303-0.066-005 012-00066-00 PT SW SW 17-2-92.12 AC
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
n C111 ED rvtil cc. 9e"" e r kvv)
0Addresss(number and street, r
city,state,an^d ZIP code) - ---— — 0 Same as pmperty address-- ---
—
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) 0 Same as propene address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sore
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
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PART 4:ADDITIONAL INFORMATION