Homestead_WellsCLAIM FOR HOMESTEAD PROPERTY TAX
s CREDIT /STANDARD DEDUCTION
State Form 5473 (14215-92)
Sl
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
,;'CERTIFtCAT*N STATEMENT` „ ..�_ ; . • . {�: -..
�1
SWe) Lgbri R �f- K.o D �i F.. W e-'�C certify that on the 1 st day of March, 19
le) occupied as our principal place of residence the following described real property for which a Homestead PropjpgalCr reby claimed:
ETe (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 th roperty r isAuyin/ `g'under �(pnffact.
.:CONTRACT RECORDED-..,
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
" PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTION -
Counjjyy..
lz.
Township // 1
L)Q-6h 0
lazing district (city town, township)
(1c)
Parcel number
D co O :t o-o
Legal description
-� qt 1 3.50A-c." 3 0
It 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.
" PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
tereby certify the above statements are true, correct and complete.
,VALUE.
cure of claimant
VALUE
Address (number and street, dry, state, ZIP code)
2 ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL'
o
,VALUE.
VALUE,
VALUE
VALUE -.
Land not exceeding i (one) acre immediately
Valuation or $2,000
-
surroundingresidentialimprovements.
(1)
-
Other land
(2)
-
Total land (line 1 plus line 2))
(3)
Dwelling
(4)
Residential improvements
;
-
Garage
(5)
"
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pfis line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
�ilying 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 signed
t -
I
. • STATE FORM!35'9 OW HI./ MEASURER FORM TS-IA
APFRT'm BY STATE BOARD OF NIV➢:.\TS._IMM PRssAlam BY THE OEPMTS¢VT OF LOAL&A'LRYMEXT FINANCE IC 6-1.1-2Z-I.1
• 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 deduction becomes
® mote beneficial,there is more incentive than e'er for homestead fraud.Homestead fraud causes 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 Lept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will we this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address /I n
Wells, James A/Robin L 1
R 1 Box 94 1n
Patoka IN 47666 - `Y
266
James A/Robin L Wells
R1 Box 94 State Parcel Number Legal Description
Patoka IN 47666-9121
26-05-57-092-000.245-017 009-00245-00 PT MD 92 1-10 3.30 AC
t o ut It II nt I I t I I I r I unt I I tl I t I nt I I t I t I u I I I to I I
D-12 C-1
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
Owner I First Middle Last
JCVnES %A/an l�e(ls
•Tg Address(number and street,city,state,and ZIP code) ❑ Same as property address
2sC° N. Shy'/v4 Ed ,.fo% , /064.4 //7/
.
Spouse First / A Middle / ' / Last
Lb,4 L/17n /.5
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as propene address
2s6 N. :AA ect4 1194-� bbl 2717,i‘
) — — —
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.
Own S Date
'(
PART 4:ADDITIONAL INFORMATION
•