Homestead_EmgeCLAIM FOR HOMESTEAD PROPERTY TAX
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CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/ 5-92)
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INSTRUCTIONS: See reverse side for tiling instructions.
- CERTIFICATION S
FORM- YEAR
HC10
I (We) ( C /' certifyAhat oHp1VQ, Ily OfMDarch. 19
.:) occupied as our princ al place of residence the following desdrib eal property for which a Homestead Proper ax Credit iI by if
L, 1 (We) owned ❑ Are buying under contract 1 JJ
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pr�ejV,,d is'bal g ntler a contract.
..- CONTRACT RECORDED - . - If buying on contract. Fee Simple owner's name .
Recorder's office where contract is recorded Record number Page
e PROPERTY DESCRIPTION -
Coun. C — / - - To hi Taxing district a , town, to nship)1 ' L
Parcelp�mb> =r �Q! L (description.
If 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
eb erti the above state nts are true, correct and complete.
Signature of claimant
yy��ddress �(um��be�//r and sVeeL ,state, zIP e)
ASSESSOR USE ONLY
TRUE TAX
.VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Otherfand
(2)
D ' sign
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
-
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Sgnature of Auditor -
Date signed
L�
- STANDARD DEDUCTION ALLOWANCE
19 —Pay 19
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Audit
D ' sign
SIAM FORN!)!M IIL'/Low l TIrAStaEA Po0.4—IA
APPROVED BY SIAM M117D Of MYit:YTS.9• PrEYA1aED BY rot DEPARhaNrlr LOCAL rovrt`MFAT FINANCE pre-Lt-rat
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 ner for homestead fraud homestead fraud causes higher tax bills for all:therefore.
H@\ 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying infomtanon necessary.to allow county government to better monitor homestead
fillings.'Ibis information will he kept confidential and can only be accessed by authoriml county oficials.'the Depanntent 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
Emge, Stanley R/ Rebecca J
Po Box 323
Ilaubstadt IN 47639
8297
Stanley R/Rebecca J Emge
Po Box 323 State Parcel Number Legal Description
Haubstadt IN 47639-0323
' I II III II I I II II ' I II I I III I I 26-19-31-400-000.695-009 013-00695-00 BR(ARWOOD 19 Briarwood
I I I III I I I I I 1 t t l III I I I III I t l r r t t Sub Div II Lot 34(.482 ac)
•
PART 2:TAXPAYER INFORMATION
Owner I First W DBezt. Middle Last
— — g Address(number and street,city,state,and ZIP code) ❑ Same as property address —
-
C,0. Fes,( 3a3 iwe 1-tAxe- D-r- , b—t 47(O7R
Spouse - First Middle • Last
r;CC R �}N E E M 6 r
Mailing Address(Number and street city,state.and"ZIP code) Same as prepeny address
PM . Bost l3a3 bbh Aver b\Pucasi D'1 tN 47103\
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
BART 4:ADDITIONAL INFORMATION 'f