Homestead_Dixonrty
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
° ° I State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Government Finance
............ ....,.... ,..cc ,c.mac aruc mr ueng ux5lruCUorls.
YEAR
I (We) v u' , / r that on thpJl1Aa6&1I j00 j0_
I (N occupied as our principal place of rest ence the following described real property for whi a omestead Property Tax Credit is hereby claimed:
•L�J! I (We) owned ❑ Are buying under contract
® Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pr I S(6 u Imo t n
IY
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
X45 .�'� Ate, PROPERTY, DESCRI Mdfll _
County
Township
Taxing district (city, town, township)
Parcel number
Legal escri q/Li�on Is the property in question:
O ° ❑ Real property ❑ Mobile Home (I.C. bf.1 -7)
any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
APROP, ERTY; OWNEDBY�CIAIMAH7 ;IN'.OTHER'COUIJTIES'�x=.sl.,w
County
Township
County Township
hereby certify the above statements are true, correct and complete.
azure of claimant
&r numbers skeet c' ,sfate, Pcod )
"AT.c100 %OF TTV,,I?
YASSESSOR '=w
1�
TRUE TAX .-5g
ASSESSEDVALUE
1 HOMESTEAD7�
NONE - RESIDENTIAL "- �+
f�'u'�'CrtVALUE`�'T-
�S .x-sa 3
3'�G.1'..
VALUE-
"AT.c100 %OF TTV,,I?
-VALUE
!
�.' CtTrt .i
Land
1
R ,s, saw' _� �'•$ to
rrounding residential improvemenLS�iatety
Other land
(2)
J +y'
Ya9A
-' .-1'-"e..'
Total land (line 1 plus line 2)
(3)
Dwelling
(q)
ti
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
.lAlE 1 DIVA!)w IILI3+"1 WARMER RAN lSIA
.ArrnwEo BY EMYTE WNW Of ARY!.\Tl.].M PIEYRIDID BY Tilt DEPARTME1T Of MCAT&WZRNMEA'r ED:ANCE ro.1.I-r4.1
Gibson County Auditor HOMESTEAD PROPERTY OWNERS IMPORTANT NOTICE TO HO
101 N Main
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 riser for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires uxpa.ers who recei.e 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 he kept ronlidentinl and can only be accessed by authorized county officials.The Department of
Local Government Finance will toe this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ ' Dixon, Loren T II /Ann Petitjean .
434 S West
Ilaubstadt IN 47639
3426
Loren T Dixon II/Ann Petitjean II
434 S West State Parcel Number Legal Description
Haubstadt IN 47639-8155
I Ijt tljtttjrljt trtjjtjtjttjttlttt tjlt�tlEtltlttt llrtlttltltlt� 26-23-06-300-000.128-009 01300128-00 PT W 6-4-10.771 AC
This 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
over\ a ea. S _ ►X0
le Address(number and street city,state,and ZIP code) • Rae as property address
4:32 • 1 S+ S4rc - —. - ct 7b 3�l
siTicn . First Middle Loa
Mailing Address Address(N�umbbeer and street,city.state,and ZIP code) ❑ Same as property address
. . - .• - -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 1 Sign Date
PART 4:ADDITIONAL INFORMATION I. •
I