Homestead_RussellCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R6I4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filirfp instructions.
N,
FORM YEAR
HC10
I (We) V� 1 + V certify th o th is a of arch 0
I (We) oco pied as our pdncipal place residence the following described real property far which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract MAY 0 9 2006
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.
If buying an contract. Fee Simple owner's name
Recorder's office where contract is
Record number I Page
` `''.�`.t ' +` > z^•r^, :_�;' �.
y� ,R OP,ERTY,DESCRIP.TION 1. �''�' -'r m t -
�P, �'s:.i:' a .0r' A',c :'='-
County
Township
Signature I claimant
Taxing district
5
m ; 40/ �o / ^7r
QL �fu
Legal descdplion
ASSESSED VALUE
�ATit 00Ye'OFiTN
Is property in question:
.F�aal property ❑ Mobile Homo (I.C. 6.1. 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 potion
of the property utilized to produce income.
.v °''''s >�1�" --_ £,aKPROP,ERTYOINNEUBY CL'AIMANT•IN' OTHER" COUNTIES +,�'r �qiy �.`,.,`,- ,'` {'S:gLy'x
County Township
County lTmnship
I hereby certify the above statements are true, correct and complete.
Signature I claimant
Address 'number and street city, state, ZIPcode)
1-77 A2r,7bkg,- 666
5
valuation or $35.000
ASSESSED VALUE
�ATit 00Ye'OFiTN
{�HOMESTEAD't
,VALMar
:"'� NO -RN EStDENTIAL +
y�
Land not exceeding 1 (one) acre immediately",
surrounding residential improvements.
u3a
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
- } Map. f
Y� $
YR.
(Residential Improvements or Annually
> a
'`'`'°'_ ' f
Assessed Mobile I Manufactured Home
Garage
g
l5)
•�. r as'€jA • -•,
r�z �1wz
`=` �. X:.
Other improvements
(6)
`?
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(S)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
,:•.� �•<„ x�<, �7g. �{ �i�., �' 3}- �;>,'3��-STANDAR�:DEDUCTION ALLOWANCE
20_Pay 20_
Lesser of 1r2 Homestead
5
valuation or $35.000
Signature of Auditor
Date signed
STATE FORM 5350(R3/B-t0) TREASURERS FORM TSIA
APPROVED BY STATE BOARD OF ACCOUNTS.2qq PRESCRIBED BY THE DEPARTMENT OFLOCAL GOVERNMENT[MAW"'IC 6-U-22.1
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
Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud muses higher tax bills for all;therefore,
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are 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 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 homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Location Address
FILED Russell, Mark Joseph
4538 N SR 65
•
PATOKA IN 47666
141 APR 2 5 2011
8) Russell
453 C J.n V I II I�Iii:fiH�IIIII_�III �II I_�III�I II�II�OII�II_II�IllhI]l�II�II��II�III �I�IIIIll
4538NSR65
PATOKA IN 47666 GIBSON COUNTY AUDITOR
State Parcel Number Legal Description
26-05-15-200-000.670-017/ PT LOT 1 FR 15-1-10 1.055 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.
PART 2:TAXPAYER INFORMATION
OwI - - First - Middle Last
/U1arK , yosepi
Mailing Address(number and street,city,state,and ZIP code) Same as property address "
L{5 38 Ai se 6 5— f a� Gale /.✓ 97!66
,
Spouse First Middle Last
'— Mailing Addr[ss(Number and street,city.state.and ZIP nod a----` – - _. —.— Same as property address–`.— - - —
Social Security Number(last 5 digits) Drivers Licence/State ID Number (last 5 digits) "- Other(please specify in Part 4 below)
1I I I I I I I I Site
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//S/ig//moue Date
)
PART 4: ADDITIONAL INFORMATION
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