Homestead_Keller°a CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
INSTRUCTIONS: See reverse side for filing instructions.
STATEMENT
FORM YEAR
HC70 ��uupp''°°��''11
� - L- A
t i "w
'e) C- Q A.) certify that on the 1 st day of March, 191
�_) occupied as o principal place of residenc he following scribed real property for which a Homestead Prope x r i i4erdg4.l�i E3:
l(We)owned ❑ Are buying under contract _ AU�R
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.
CONTRACT RECORDED. - -
If buying on contract. Fee Simple owner's. name
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTI
County
Townshi
Township
-
Signal
Taxing tli i t (city, own,
town h'
)
Parcel number
3 - (O
Legal d scri
`W (-q- /(6 . s
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
reby certify the above statements are true, correct and complete.
Signal
a of claimant
AM (number ark street, dry, state. ZIP code
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON -RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2)
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 pUs line 7)
(g)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
tying action - Signature of Auditor
Date signed
19 _Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
S
U
STATE FORM MOO(L/AIM , T[EASLAf3EORMTSIA
.., - APPROVED BY STATE BOARD OF ACCOUNTS.2109 PRESCRIBED BY TIE DEPARTMENT OF LOCAL COVIXNMEYTFDIA`XE IC 4.I.1-z2-S.l
Gibson County Auditor" 1 IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
-101 N. Main Street Individuals and married couples are limited to one homestead standard deduction As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
_ - . ' HEA'1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the.
FILED flingt and to provide additional identifying information andca neny be callow-county ized count oto fficials.ciaer Trl The De homestead
filings.This information will be kept confidential and can only be accessed by authorired county of5cials.The DepamnrnTOf
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
I • :PART 1: PROPERTY INFORMATION -
APR-6 2011 Taxpayer Location Address ,
C. n - Keller, Gary:A/Kathy L
422 S WEST
GIBSON COUNTY AUDITOR • HAUBSTADT IN 47639
3012
Gary A/Kathy L Keller II 1 11111-III I VIN III II I I-BIIII III II IIID 111111 II I I1-I I 111111111111 ill
422 S West
Haubstadt IN 47639-8155 - -
PIII'Iii'IIlliIilII 'lI'Iliml illIII1IIIi1llillllllltiitrlllll State Parcel Number Legal Description
-- —_ — — — — 26-23-06 301-000.286-009 �PT W 6 4 10.50 AC
This form MUST be returned to County Auditor's office. ,
Please do NOT send this form back with your tax.payment to the county treasurer.
r,1 • - • 1 PART 2: TAXPAYER INFORMATION
Ow_. I First - c , Middle Last
7a
er . ,, • item • ��lf '.
Mailing Address(num and street,city.state,and ZIP code) ca Same as property address •
' .,
Spouse r First i - Middle Kr: , / r (� Last
Mailing Address(NUmbesndiveet.city,state,IndZlPedde): __ ----_..__--------__ •a.'I�:$amc perty address'- ----°— - _
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-fmancial penalties.'
Owner I S'..: a��'.4 / / /_ Date
:PART 4: ADDITIONAL INFOR:\1ATION