Homestead_Rode (2)e 4 CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
t s State Form 5473 (R2/5-92) '
INSTRUCTIONS: See reverse side for tiling instructions.
YEAR
CERTIFICATION STATEMENT I ,� ^i �j..y' -,. ,� -..•r. :_,. - ' - _
t (We) V/ cenify, th'at on the, f a
I st daybrch, 19
/We) occupied as our principal place of residence the following described real property for which a Homesliee�'ad Property TartCCr�?,q,' ereby claimed:
yJ I (We) owned ❑ Are buying under contract ,l°!,,(J • �:"' G^
El Have a beneficial interest in the entity that is liable for the property taxes on the property and that owes ffle.property: or -is buying under a contract.
_ CONTRACT RECORDED.
It buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
"
- - PROPERTY DESCRIPTION _t ` - . 1.
County
GfbSVn
Township (✓t% S �1 t✓1 /-0,1
Taxing district (dry, town, township)
Pa0o q - o,a o /
Legal description .
It any portion of the residential structure or the land not exceeding one (1) aue that immediately surrounds that structure is used to produce income, desuibe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
ereby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street dry, state, 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.
-
Otherland
(2)
-
Signature of Auditor
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
°
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pus line 7)
(g)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
tying action - Signature of Auditor
Date signed
- STANDARD DEDUCTION ALLOWANCE-
19_ Pay 19_
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor
Date signetl ��/�
MIT FORM 5)Y.01:IYMI f.. clSU FORM 5-',
.VfMA'fD BY STATE BOARD Of MTq:%Ti]rw Plc RIBFD BY THE DBPARTHECIOF LOCAL tMWILNMESr FD:AYTE IC11.1.1.214 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 standard deduction.As the receipt of this deducion becomes
0 more beneficial,there is more incentive than ner for homestead fraud.Ilomesread hand causes higher ta'bills for all:therefore.
HEA 1344--2009 requires taxpayers who remise the homestead standard deduction to verily that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings this infom nation will he kept conlidential and can only be accessed by authorized county officials.The Ikpanment of
Local Government Finance will use this information to create tools that will help county official,eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Rode, Devin W
RI Box 42
Francisco IN 47649
1138
Devin W Rode
2957 N 775E State Parcel Number Legal Description
FRANCISCO IN 47649-9267
IlltrlltIIIIIlrttltrlllltlIlIlillIlllIIliIlttllltlllttrllIItll 26-06-28-300-002.817-017 009-02817-00 PT NW SW 28193.20 AC
C-1
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
r
T e r i,� Lu. �y R c� t°
•ng A'd&ess(numtier and street,city,state,and ZIP code) - - l Xt Samc as pcopem nddrms - - - —- -.
Spouse First Middle Last
Medina Address(Number and street,city,slate,and ZIP code) ❑Same as property address
Social Security Number(last 5 digits) Driver's License/Stare ID Number (last 5 digits) Other(please specify in Part 4 below)
sus
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.
Ow Cr . azure Date J
( )
•
PART 4:ADDITIONAL INFORMATION
7 Y