Homestead_BurchCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5.473 (Re f 4-W)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filina instructions.
I (We) occupied as our principal place of residence the following described real property for which a
❑ I (We) owned ❑ Are buying under contract
FORM YEAR
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.
NTRACT-, REC_OR_DED�.'`- �.,+-avi�=`''sH'
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
.`E��°_ �.?°�, cfa-"
�"• M
2-rfi,ROPERTV�DE SCRIPTION
County
Tavnship
Tmnship
Taxing lrict (city, town, to hip)
Pa cel mbar '/ // 11
vV
Legal description
dress (number ,a�nyd�street, city
203 II lair1
Is the property in uestion:
Real property ❑ Mobile Homo (I.C. 61.1 -7)
N any portion of the residential structure or the land not exceeding one (1) awe that immediately surrounds that s6ucture is used to produce income, describe the use and portion
of the property utilized to produce income.
WASWEE - _
i PROPERTY OWNED BY.CL'AI"NT
IN,OTHER`COUNTIES,
County
- NON,RESIDENTIALM'n
Tmnship
County Township
I hereby certify the above statements are We, correct and complete.
Si na o aim;
dress (number ,a�nyd�street, city
203 II lair1
ate, ZIP code)
Q e
N Iq 7 6g
ASSESSOR USE ONLY
'ryTRUETAX
7SBESSED VALUE
HOtdESTEAD
- NON,RESIDENTIALM'n
_ °r :r. <o-:-1
� VALUEy
fAT�100 %AF "TTV
ax;;ye .VALUE,fc?
z�,. .. VALUE
not exceeding 1 (one) acre immediately
(1)
-a�Land
�""` � - '�'`1"
Op ev.
surrounding residential improvements.
a,� ,... =i
Other land
2
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)
s
IM
Residential Improvements or Annually
Assessed Mobile Mobile I Manufactured
rred Home
(5)
LUD
4
Other improvements
(6)
;
u
Tctal improvements (line 4 through line 6)
(7)
Total value (line 3 p1m line 7)
(6)
hereby certify the above is true, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
' ,_% ' 'S,sa.€—.' '`'s 'oi`aX #, "3e r' 'rs',*><' ss' STAN DARD!DEDUCT10WALLO WAN CEyt:'
20 _ Pay 20 _
Lesser of 112 Homestead
Valuabort or SM.DO0 FS
Signature of Auddw Date signed
STATE r0KBl.'3W,r t!.-474 t IPEASl LER FOP-47 M
.ArrRtwto BY SERE mr .MTY•oTS roe PRTflWbiD BY THE BEPMTe4T(*LOCAL GmcRNMrwt FINANCE/I' I.1 r4.1
• Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple ate limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eta 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 reeehe the
benefit and to provide additional identifyin_ information necessary to allow county government to better monitor homestead
tilinv,.This information will be Lept confidential and can only he accessed by authorized county officials.The Depannmt of
Local Government Finance\Sill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Burch, Donald K/Sherrie D
I'013ox 310
Somerville IN 47683
8459
Donald K/Sherrie D Burch
P 0 Box 310 State Parcel Number Legal Description
Somerville IN 47683-0310
It'ttl'Itt ltl'ttlt tlt EEl dill ��Ittt����tttttt����ttt�ttt�� 26-20-02-403-000.141-003 020-00141-00 VANADA ENLG 31/32
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
DOnaQt1 KwV l Q to urc
in Address(number and street.ci
ty,state,and ZIP code) - --- —I VI Same as property oddess -- — -
203 rnU;n Pee 3 t ®
Spouse 1 First \ Middle II Last
SYi2frie., DQn ( S _ urck
Mailing Address(Number and street,city,state.and ZIP code) Same as property address
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