Homestead_Daumat�ry °s CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
8'= CREDIT /STANDARD DEDUCTION -
:, • State Form 5473 (11215.92) I -9 1 9%
INSTRUCTIONS: See reverse side for filing instructions.
_ - -
CERTIFICATION STATEMENT -
I (We) certify. that on the 1st day of March, 19
) occupied as our principal p ce of residence the lowing described real prope or 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.
CONTRACT RECORDED - - - It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township
Taxing district (city. town, township)
Parcel number
Legal description
Obq ^ob((�(. -ao
Address (number and street, city. state. ZIP code)
4 a p -KA j �+• t- �Ob
It 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
*eby certify the above statements are true, correct and complete.
Si nature or claimant
Address (number and street, city. state. ZIP code)
4 a p -KA j �+• t- �Ob
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
$
Other land
(2)
Date signed
- `-
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 pits line 7)
(6)
1 hereby certify the above is true, correct, and
complete. '
Signature of Assessor -
Date signed
Verifying action - Signature of Auditor
.`
Date signed
- - STANDARD DEDUCTION ALLOWANCE
19 Pay 19
Lesser of 112 Homestead
Valuation or $2,000
$
Signature of Au itor
Date signed
- `-
\ _
Mil 1 ORM!!!m lR:/ MIASMA EOM ZIA
.AITMO'ED DV STATE BaaPDDF Ann:AN\TS,31N FRIYNBFD BY T1If DEPART6`rr(1FLOt'ALCIWEPT'MrWT FINANCE IC4-I.1-224.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than exer for homestead Fraud.Homestead fraud causes higher tax bills for all;therefore.
® HEA 1344-2909 requires taxpayers who receive the homestead standard deduction 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.ibis information will he kept conlidemial and can only he accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Daum, Larry J/Sandy
590 N
['ATOKA IN 47666
908
Larry J/Sandy Daum
5253E 590 N State Parcel Number Legal Description
Patoka IN 47666-9130
I I I I III I I I I I I 1 1 1 1 1 1 I I II I I I 26-05-47-125-000.166-017 009-00166-00 PT LOC 125 1-10 16.749 AC
t u ur r tit tit tit tutu ti t use I tit t nl C-1
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
1'y1
•ng Address(number old street,city,state,and ZiP code) ( Same as property address - - • - - - -
Spouse First Middle Last
Mailing Address(Number and street,city.stale,and ZIP code) I�Same as property 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 financial penalties.
Owner I Signature Date
PART 4:ADDITIONAL INFORMATION
•