Homestead_BaggettCLAIM FOR HOMESTEAD PROPERTY TAX
CREDMSTANDARD DEDUCTION
State Form 5473 (R7 I S-0M
Prescribed by the Departrnerd of Local Govenvnent FSnersm
INSTRUCTIONS., See reverse aide for Ming insbmdom.
Fj#PC ]
SEP 2 6 2007
I (We) /7 . cerWdl?bf Vn'ft Vgf day'of'Maich, 20
nop(It9follovving described real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) occupied as our principal place of r=esKle =
I (We) owned ❑ Are buymg 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-
"T
CONTRACT�RECORDE[lrt
If buying on ..bact, Fee Single owners narne
Pzoxdeft oflice where cm*ad m recorded Record number Page
PROPERTYIDESCRI[MOIC:'
County
County
Taxnship
W
17����
I hereby certify the above statements are true, correct and complete.
Parcel r"rd"
desorption
Date Signed
I
Irr d W 9 0 -1-7
.
❑ Mobil. H. (LC. 61.1-7)
tf+ Potion ot the residential struchme err the hard mounds dud structure m used to prod" ismrne, describe the use and portion
dl;;propwty uti(®d bD Prod" income.
oUp-o6— 17—oV00-000. Y004,-0/7
9/"k 3� �It &Y WOTHER CouSIN": �4.fa;— ';aA
County
TwmNp
County r
Township
I hereby certify the above statements are true, correct and complete.
$
or(nualf" and Street 09; stsftl. ZIP
-7Z571 6- A) Sc0
►1
20_ Pay 20—
Lesser of 12 Homestead
j;,'NoN4mmDEwhAL
ASSESSOR USE ONLY r%
$
-Agnstum of ksmor
Date Signed
Land not exceeding 1 (ono) am invnedialaty
summd'WQ residential improvernents.
Other Law
(2)
TctW land (Ikv I pkis &m.2)
(3)
Dwelling
Dweng
(4)
Residential improvements improvements or Annually
Garage
Assessed Mobile I ManufachmiDd Home
(5)
Other unprovemnents
(6)
Trial irnpravernents (rme 4 through Im 6)
Thal value (line 3 ph& &* 7)
(8)
I hereby car* the above is true, correct. and
ate.
Solsbure of Asaesaer
Date signed
dying action - Sitpurbure of Audtor
Date signed
20_ Pay 20—
Lesser of 12 Homestead
Valuation or 535.000
$
-Agnstum of ksmor
Date Signed
•
STATE FORM 53J141R_/I$I TREASUITA FORM isty
.APPROVED BYSTVLNMROOfACMUNTS.-wx IRESOUnm BY'Br DEPARTMENT OF LOCAL ta RNMERT FINANCE 1C1.1.1-224 1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are [united to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentnr than racer for homestead fraud Homestead fraud causer higher tat bills for all:therefore.
III HEA 1344-2089 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information rmces>ary 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 Ikparmmu of
Local Government Finance will use this infomution to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Baggett, Samuel A/Shannon L 7a S I E cook)
l 6A
T/f`
Patoka IN 47666 r3 I
291 1 )-06
Samuel A Baggett O
7251E 500 N State Parcel Number Leal Description
PATOKA IN 47666-9143
26-06-17-400-000.486-017 009-00486-00 PT NW SE 17-1-95.473 AC
IriullutllllurI1ut11u1t1untiItInInllnlllnn11111111
C-1
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 �j,( - Last
Sgnir,Ie/ 4e-r6k2 e aG(2, -
sg Address(number and street_city,„ate,and ZIP code) in Same as property address
-72 sr E Soo fJ hA-f-o KA) -N 47 (0(0G,
Spouse First Middle Last
-In aNnln1U L et�G, AGSP
Mailing Address(Number 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 I Si: Date
a PART 4:ADDITIONAL INFORMATION
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