Homestead_Miller%^ov
a � CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
i State Form 5473 (R2 / 5 -92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC70
_�. V / certify that on the 1st day of March. 19
�1 occupied as our principal place of resid a the following described real properly for which a Homestead Property Tax Credit is hereby claimed:
,J I (We) owned ❑ Are buying under contract
IT f�� r.
❑ Have a beneficial interest in the entity that is liable for the property taxes on the properly and that owns the property ,ppp'���,,,7rs b'uying under a contract.
CONTRACT RECORDED c�El�.. j iQGG
f buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Recortl nurnber �, 'Page
r�UDf►bF'
PROPERTY DESCRIPTION A 7T
County
Township
Taxing di n ly. ov rownshi
rc mh
'/,� 0
Legal description
Valuation or $2,000
It any portion of the residential structure or the land not exceeding one (t ) acre that immediately surrounds! t 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
�eby certify the above statements are true. correct and complete. Sign - -e of claimant���
Address (ncu�mber and street. city. state. ZIP code)
!� I�elmo�ct �riJe. 1—FC�u�-tr.,�� ITJ �k�c�3g
ASSESSOR USE ONLY
TRUETAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE
Land not exceeding I (one) acre immediately I
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Auditor
Other land
I(2)
Total land (line I plus line 2)
I (3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line l
I (6)
1 hereby certify the above is true. correct, and
complete.
I Signature of Assessor
(Date signed
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 Pay 19 _
Lesser of 112 Homestead
S
Valuation or $2,000
Signature of Auditor
Dat ned — ^/ / `��')
CJs /" /
•
HATE IORSt fife/471 WARMER FORM titA
.APPIIMEt BY Sinn BMRIMWArTTXITS.21"S YWWTIBWTBY THE DEPART Of LOCALGOl2LYMCNT FINANCE is f-1.1-32-t.'
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 err for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard de duction 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 confidential and can only he accessed by authorized county officials.The Department of
Local Government Finance will use this information to create awls that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Miller, Charles C/Jolee A
104 S Damosa DR
Haubstadt IN 47639-8159
2711
Charles C/Jolee A Miller
104 S Damosa Dr State Parcel Number Legal Description
Haubstadt IN 47639-8159
�t�n��n B�t��nn�luit�n�n�nnlltlu�r�t�n��nn�t t�r�•.�� 26-18-36-403-000.238-009 0013-00238-00 WEST HGTS 2ND ADD 104
_ —_ _ _-_ — —- _—_- __ _ ___
•
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
egg Address(number and street,city,state,and ZIP code) =a>:me as property address
Spouse First Middle Last
J 0 I-r ,4'J4✓ /GCE 2
Ma Hine Address(Number and street,thy,state,and"LIP code) l&:ane 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 Signature B�pp Date