Homestead_McConnella •4 CLAIM FOR HOMESTEAD PROPERTY TAX
- -; = CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/1 -90)
I (We)
FORM
HC10
INSTRUCTIONS: See reverse side for tiling instructions.
CERTIFICATION STATEMENT
• .,M c
certify that on'the 1st day of March , 19
We) occupied as our principal place of residence the following described real property for which a Homestead
1' ,
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 it under a contract.
If buying on contract. Fee Simple
Recorder's office where contract
PRAPFRTY t1FSCRIPTION
County Tow Taxing Distric C t , to n, tb ship)
Parc I Number Le criptio
ftJp511 I 0 I- O I•eo A-C
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc-
ture 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 jtjr8(V%0ipI
hereby certify the above statements are true. correct and signature O S
complete. -
Address (Street, number, city, state and ZIP code)
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other land
Total land - line (1) plus line (2)
Residential improvements Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
(1)
-
19— Pay 19
Lesser of 1/2 Homestead
(2)
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
-(4)
-
Signature of Ai/di r
0.
(5)
(6)
(7)
(8)
1 hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19— Pay 19
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Valuation or $2,500
Valuation or $2.000
Valuation or $1,500
Valuation or $1,500
Signature of Ai/di r
0.
Date Signed
G ,ais _
IN
SIAUE FORM 5 aIR_/F+rn TRFANRFR FORM 79-IA
.APTROVED BY SN1L MVtO OF■Ye%iNtc, FrIntBrn BY Till DEPARTMNTOF LOAIIXwrtMMFNT FPASCE ICHb_a.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limbed to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e.er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• NEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifyine information necessary to allow county government to better ttwnitor homestead
filints.Ibis information will be kept confidential and can only be accessed by authorized county officials.The Depanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
McConnell, Lee/Edwina
R I Box 24't '
azleton IN 47640
777
Lee/Edwina McConnell
4082 E John Ford Rd State Parcel Number Leal Description
Hazleton IN 47640-9351
I I I I III I I I I I I I I I I I I I I I I III 009-00517-00 PT MD 109 1 10 20.00 AC
1 11 III 1 111 IF III 1 1111 II 1 1111 11 111 1 111
PART 2:TAXPAYER INFORMATION
Owner I First nn Middle /� Last
L& e /� �JIrJ � �I OCOnne If
e Addreis lmmiber end-street,city,stdtc.andZIP code)_ _. _ _ _ _ _ aSamc as property odd resa
4 O E ao\`\r t c \-kc\ get,72r fan -_u Via;Vo
Spouse First Middle Last
(CIO n G S(-4,t: 41 &Cann 0/I
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
L\oE;)i So\\r occL 4. /Ic -1>;4 Sn) Y74c yd
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
1 I n I/
1107-a:�Pr�� WdAt s \ket.- n4vnVa L•s. 4\.e rid t- �c -I'I\sc L%Ir� ndr�.rrt< Abl '}AR FF Q// tduc,.s
