Homestead_FultonCLAIM FOR HOMESTEAD PROPERTY TAX
i CREDIT /STANDARD DEDUCTION
_.,I. State Form 5473 (R2 15-92) -
6
INSTRUCTIONS., See reverse side for filing instructions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT
I (We) certify that o4e of March, 19_
-
I (We) occupied as ou dncipal place of residence the following described real property for which a om T. es� d�rope dit hereby claimed:
❑ I (We) owned ❑ Are buying under contract r t
❑ 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.
MAY 10 2001
CONTRACT RECORDED
If buying on contract, Fee Simple owners name (
�
Recorders office where contract is recorded 1111J11' ecord number
Page
PROPERTY DESCRIPTION
County
Township
Taxing dis[nct (city, town, township)
Paroe umber
Legal description
d o -o -or)
a\ k l as
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 COUNTRIES
County
Township
County
Township
certify the above statements are true, rect and complete.
tore of clai
ereby
dress (nu lands L city, state, ZIP mdeJ
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE -
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other Land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
-
-
Garage
(5)
Other improvements
(6) _
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
verifying action - Signature of Auditor Date signed
® STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead $
Valuation or S2,000
Si
ure of Audi
Date signed
OS —(ici-o
stmt.FORM!lY. it/5-+q TREASURER FOR4i-IA
APPROVED BY MATE Brl\AD OF scram ION ranARlam BY TIE DtF ThEV70F LOCAL novEnMTN"r FPe&SCE M VI.Iv'J.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standani deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ever for homestead fraud I lomestead fraud causes higher tax bills for all;therefore.
•
HEA 1344-2000 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reeeise the
benefit and to pr side additional identifying information necessary to allow county government to better monitor homestead 5/
filings.This information will he kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homca-tcad fraud.
PART 1: PROPERTY INFORMATION \\fYI
Taxpayer Name Property Address
Fulton, Hugh M ((�x
none '^'}
Fort Branch IN 47648 w
466 l v
Hugh M Fulton �Y
R1 BOX 100 State Parcel Number Legal Description
PATOKA IN 47666-9126
26-05-57-121-003.081-017 009-03081-00 PT MD 12111025.22 AC
It I tt II alt It II tat II tut II tt It I tlttt
C-1
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
/1/41 / 9 FU/ 749//
�g Address(number mod strexx,city,Seale,and ZIP code) -- -- — — "— a Same m propeny uddst. — --— --
t/
Spouse Firstl Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
suit
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 1 Sign, Date
S,:dse iv . • Date Telephone
PART 4:ADDITIONAL INFORMATION