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Homestead_Folsom (3)e.� ^l",\ CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
A State Form 5473 (R2 / 592)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
IlkV V I 1 %d"
PROPERTY DESCRIPTION
CERTIF TIO STATEMENT
Taxing distric (ci . !or n. • wnshid
r .0 h /I /0 ^ O Legal description
1 twe)
certify that on the 1 st day of March. 19
16) occupied as our principal place of residence I
ollo I g descrt ed real property for which a Homestead Property Tax Credit is hereby claimed:
h (We) owned ❑ Are buying under contr
NON - RESIDENTIAL
VALUE
❑ 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.
Other land
(2)
CONTRACT RECORDED
It buying on contract. Fee Simple owner's name
NOT �
tlD ®tl � C lJJ}E J
Recorder's office where contract is recorded
(3)
Recor mber - Page
IlkV V I 1 %d"
PROPERTY DESCRIPTION
County Township
Taxing distric (ci . !or n. • wnshid
r .0 h /I /0 ^ O Legal description
If any portion of the rresidential 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 Township
®eby certify the above statements are true. correct and complete. i Signature i nt
Address (number and street. city. state. ZIP code)
ASSESSOR USE ONLY
-
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding I (one) acre immediately 111)
surrounding residential improvements.
Other land
(2)
Total land (line I plus line )
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
I (7)
Total value (line 3 plis line/)
(g)
1 hereby certify the above is true. correct. and
complete.
Signature of Assessor
(Date signed
�ying action Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
$
Valuation or S2.000
Signature of Auditor
Date signed
•
� AVE DM
TPfAAEER MBAI TS-IA
APrMm VEn nYMAEE IXAR Dnr
ACC(*.N1(.]•+ PRrBYIUBm BY Mt DEPARTMENT OF LOCAL fMZLVNIXirO:AVCEr 6-E1--11
le Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD•
PROPERTI' OWNERS
PRINCETON IN 47670 Individuals and Married couples are limited to air homestead uandard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ncr for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verily that they are eligible to reoeue the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.ibis information will he kept conlideinial and run only be accessed by authorized county oflici'als.The Depanntent of
Local Government Finance oil'use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
-- _. - - -- Taxpayer Name - _ _Property Address -
Folsom, Robin L/ Billy J
R I Box 74
Francisco IN 47649
1094
Robin L/Billy J Folsom
7127 E 450 N State Parcel Number Legal Description
Fr.anciscn.IN.47fido_o74l ,�,_„,,,, ��
'an nrxn von
�- - 0.17---•-‘10-4)0.784-00 PT NW NE 2O-1-9 121,7. A7�—
•
PART 2:TAXPAYER 1NFORMATIONN
Owner I First Middle Last
it
e'
_ ---- -- - Smnc propertj-addr.ss -
a .r ''so /v Eancisc T, S.y9cy%
�
Spouse First Middle Last
AA/'4 yn gtsa
Mailing Address(Number and street,city,state.and ZIP code) Same as property address
7/e-,Z ,/ A- 4<ro /� �Q n,c e o Z/7 `r/74 clY
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 ft