Homestead_EppersonCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT /STANDARD DEDUCTION ��� HC10
Stale Form 5473 (R6 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instarclions.
I (We) certify that on the 1st day of March, 20_
71I (W )occupied as our principal place of reside tit following described real property for which a Homestead Property Tax Credit is hereby claimed:
(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 property or is buying under a contract.
CONTRACTRECORDED�- �i. �crt�`' ��:- �'.` �'"` �' �` Fo-a3a''.'_`= �.' �` ..c�'�r',g+r''""�L'�.�'';,r,::
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
'`'-`.• c_` a- ra�sxta ''`t'k"K�'..+�-z�._'.``7_s�. ?PROPERTY .DESCRIP,TION?w...':7_,
County
Township
County Township
TRistrict (city, town, township)
Signature of claimant
Address (number and street, city, state, ZIP code)
Signature of Auditor
Date signed -
Parcel number 1
O/
Legal description
Is the property�uestion:
- c o
Other land
Real eal property ❑ Mobile Home (I.C. 67.1 -0
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 utilb0d to produce income.
PROPERTY OWNEDBY CL'AIMANTINi OTHER' COUNTIES
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, city, state, ZIP code)
'r --� ASSESSOR'USE ONLY a '�.
-TRUE TAX
ASSESSED VALUE
_}AT,�199WOFTTl
HOMESTEAD
VAI UE.,
inn..
NON-RESIDENTIAL ;T":,
'�kfiT?�VALUEatF`2��
Land not exceeding 1 (one) acre immediatelyW�y;'a
$
Signature of Auditor
Date signed -
surrounding residential improvements.
Other land
(2)
a fl
x-,15
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
NN W12,
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
(6)
a
Other improvements
(6)
w�
Total improvements (line 4 through line 6)
(y)
Total value (line 3 plus line 7)
(g)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
-E�Z STANDARD.DEDUCTION'ALLOWANCE�'° :tP 'Lw "+ y„ '_G.ip'i ir- ^�,,__
20 Pay 20_
Lesser of 112 Homestead
Valuation or 535.000
$
Signature of Auditor
Date signed -
•
t1UE FORM')!MIM_fHMI tflASLe18 FOtMi-tA
ArpRrwEn BY SrttE BOARD Of AfT4FTa.Zorn ERPXA®ED BY THE DEPMTMEYT(W LOCAL IXwER.VMEFT FINANCE IC 4-I.I-2-4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead A andanl&eeduction.As the receipt of this deduction becomes
o more beneficial.there is more incentive than ever for homestead fraud.Homestead 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 recene the
benefit and to provide additional idenufyinc information necessary to allow county government to better monitor homestead
filings.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 hap county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Epperson,Adam/Melissa A
RI
Haubsadt IN 47639
4
Adam Epperson
803 W Gibson State Parcel Number Legal Description
Haubstadt IN 47639-8133
I 26-118-36-400-000.622-009 013-00622-00 PT SE 363117.6069 AC
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
AbAm /n 1 0NA6L &Pp&25o13
.re Address(number and street,city,sate,and ZIP code) - - ._ Same as property address
'3.03 w. G b 50 5 , lie,/A 65 4a,J4 l IiU 1/7039
Spouse First Middle Last
/27 EL l 55p ANN EPrE-.50
Mailing Address(Number and street,city,sate,and ZIP code) Same as property address
8"O3 w, & L sok, 5-6, ii/a,,ks-1d L, JA1 41263?
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
ill PART 4:ADDITIONAL INFORMATION