Homestead_Hope�• YEAR
= CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
Stale Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
��1, �,, jj�
I (We) certify that the 1st ay of M��c17,�0_
I (We) occu a as our principal place o resider the following described real property for which a Homestead Pr rty Tax red, s hEr by clat ed:
❑ I (We) ed ❑ Are buying under contract OIBSON CO
U Y UDI as
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.
."- r�'•.,3� ^� .,ms's• ONTRACTRECORDEO�'�'��.?,�'��'''�.fih';x
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
6»_°'-.-- ,'.i- Fi`'.3*4✓`-�"ei.'-
` } -...35 PROPERTY: dESCRIPTION_ae:`°�1Y�— s–Xaa'"`'var.':'+._'h'C
County
Tomship
Si atur Uatma
Taring district (city,. town, township)
Parcel mum
r
Le es don ^
IQS-
13-1-)o
Is the property in question:
❑ Real property ❑ Mobile Hone ( /.C. 6-1.1 -7) .
If any portion of the residential structure or the Land not exceeding one (1) acre that immediawly surrounds that structure is used to produce income, describe the use and portion
of the property Waned to produce income. 4.16
OP.ERTY,OWNED°:BYCLAIMANT,IN OTHER'COUNTIES' ` r 4Mte
County Tvvnship
County Township
hereby certify the above statements are true, correct and complete.
Si atur Uatma
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(numpeY and street, , state, Z od
ASSESSOR USE O Y
'
fTRUEvTAX 1i
�' yA�;IJE�
ASSESSED VALAIE
dAT100 k0 gTTV t
'4HOMESTFJID
VALUE
NOWRESIDENT L
_VALUE' -G_
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
; •s,1
Total land (line 1 plus line 2)
(3)
Residential improvements or Annuagy
Assessed Mobile I Manufactured Home
Dwelling
Garage
(4)'ayr.
(5)
_ ,-:y
9,. - - ` -
Other improvements
(6)'•-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20_Pay 20_
Lesser of 1t2 Homestead
valuation or 535.000
srvunxM s:wawvut IRIASexl.a MIN IS-IA
APPROVED:n'i VIE nn■xnnr.V r r..Mi.a.■■ r7.1-Sexa4muv ate..raPAxrut.T 01 LOCAL cov} •w.cr tesewzic e-r!•_•-.a
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS"
101 N.Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
ceton IN 47670 more beneficial. here is more incentive than ever for hom:stead fraud.Homestead fraud causes higher tax bills for all:therefore,
• 1 n HH,\ 1344-IIX9 requires tacpafec war rcr_ive the homestead standard deduction to verify that they are eligible to teethe the
benefit and to proside additional identifying irfwmation necessary to allow county government to better monitor homcaead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Depanmert of
Local Government Finance will use this information to create tool;that will help county officials eliminate homestead fraud.
MAY 4 2012 .PART I: PROPERTY INFORMATION
Taxpayer Name Location Address
C'3' Hope, Justin
GIBSON COUNTY AUDITOR JOHN FORD RD
PATOKA IN 47666
953
Justin Hope II �IuI�tImW�llIuI lllll_lI I I I U II1 IDI_I 111111.111111111111111111111 I
5345E 500 N
PATOKA IN 47666-9150
liIiiI"IIiIIl1"111'11'III'III"111"IIIIIIIIiiIIIIIIIiiiiiiiIIl State Parcel Number Legal Description
26-05-47-125-003.216-017 PT LOC 125 13-1-10 4.16 AC
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.
•
First 0 Middle_--._—_. Last
cJ ∎JS / • bow4y„e ey {
Mailing Address(member and street.city,state.and ZIP code) I] Same as property address
.53 yC G saw ilJ P9-d60 Li 6,1,
.
Spouse First Middle Last
0
Mailing Address(Number and street,city,state.and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below) •
I - Sol
;.. 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
Snouse Signature ( / Date Telephone
• ( )
PART 4:ADDITIONAL NFORMATION