Homestead_Perry (3)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
1, % State Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instmctions.
I (We) ga certify rlhat on the 1 sf dayofI,]��rch�0
(We) upied as our principal p of residence the following described real property for which a Home ead Property�Tax»CrQ�itas iebfdaimed:
LK/ r hYty 1 Y JJQ1 t '
I
(We)owned owned ❑ Are 'ng under contract u ogN4 , ., n.tT
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.
+c•..+r:.ni. F''�''u� -i v yis;'' <CONTRACTRECORDED^ 3,„' "p;._,? ?•rr3'�,,«- {'`yo.., -,?2: <�
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
t>;�: Y7s _ six..kz✓'
i41a .1
'Y 9" _ _ .. __' _ ' _ - - .., *+N: ✓y s t tl. qe
County
Township
Tadng district (dry, town, township)
Parcq,lpy®be� �0�
L descdptio
Is the property
vauatton or S35.000
— / _ /
�R.W property ❑ Mobile Homo (LC. 61.1 -7)
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.
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m�'p....�`'�� -� -`.::, �vPROP .ERTYOWNED:BY'CL'AIMANT;IN: OTHER' COUNTIES, u': 4.° ���- " °�y���>�„'r�z�r,;f! -;K"k"
County
Township
County Tavnship
hereby certify the above statements are We, correct and complete.
Signature of claimant
Address (number and street, city, state, ZIP code)
SSUSEONLY
p?Vj�
°' {.VALUE„
TRUETAX h
"r , .
ASSESEA
SDLUE
AT %; TV
F0M
jA
NON;RESiUD.EE. -N.T.'sI' L ;h
?.A
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
vauatton or S35.000
$
Other land
(2)`
Date signed
•-
f`'��
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)�"..'
-..a• �. V,
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
r�.':'�'
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line n
(6)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
verifying action - Signature Ofywditor
Date signed
TANDARD.DEDUCTIOMALLOWAHCE,.w �v '... -s"�- •�-K ;�"" ;� ", , ?
2(0�(Pay 2005;
Lesser of 112 Homestead
vauatton or S35.000
$
natur fAuddorr
X��
Date signed
v.
MATE MINI MM.IR:I AID) TREASURER rO0.Vg1A
APPROVED PT MATE DNROm YY.A AEA.:MD PILEMILIDED BY Tim DEPARTKEV fitJAALC.OtatNY.rWT MASCE ICPLELA.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndividuaL and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
.• more beneficial,there is more incentive than mgr for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
HEA I S44-200O requites taxpayers who receive the homestead standard deduction to verify that they we eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.this information will be kepi confidential and can only be acces ed by authorized county officials.The Depanntent of
Local Government Finance will use this information to create reds that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Hale, Amy S
RI
toka IN 47666
907
my S Hale
4963E 590 N State Parcel Number Legal Description
PATOKA IN 47666-9128
Illttlitttlllltttlltttllr11.111rrrllrtllllrtltrllrttrlltrtllll 26-05-47-124-002.638-017 ON-02638-00 PT LOC 124 1 10 1.00 AC
At
. PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
AMA S �s0.n ( \'40,\ Pc) Q� t' r `/yI
•tg Address(number an4strect,city,state,and ZIP code) Q Sime as property address / - -
L44b3 E 590 NI eo. Ka -T N H -) G1D
Spouse First Middle Last
Mailing Address(Number and street,city,state,and"LIP code) ❑ Same as pmpeny address
Social Security Number(last 5 digits) _ Driver's License/State ID Number (last S digits) Other(please specify in Part 4 below) -
Sate
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
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