Homestead_WhaleyCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
Slate Form 5473 (R6I4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instrurtions.
I (We) — certify that on tl1 t d9y offMfarcE-TedD-
0 I (We) occupied as our principal place of residence the follo described real property for w i a Homestead Property -Tax Crec% ishereb 1 (We) owned ❑ Are buying under contract MAR 0 2 2004
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 on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number I Page
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ROP,ERTY :DESCRIPTION�'� rty't
County
Township
Taxing district (city, town, township)
I n ben ,�'�r�
L cri
- '�
Is the property in Question:
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.,�,.�A SSESSORiUSE ON' Y, 3z -
❑ Real property ❑ Mabge Home (LC. 6-1.1 -7)
If any-port6 of the residential atrucc w the 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.
y / /6L
'3a - 4w%?''"- .''^-1"s-' PROP .ERTY,OINNEDBX'CLAIM,4NTIN': OTHER" COUIJTIES
County
Township
County Township
hereby certify the above statements are true, correct and complete.
i ature of claimant
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d (number and street, city, state, ZIP code)
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.,�,.�A SSESSORiUSE ON' Y, 3z -
� TRUE TAX
+L " r c
;£ VALUE4
ASSESSED VALUE
,
_AT 100 %OFITV S
HOtdESTE/J
-�.
wd VALUE
.-.,.
a NON - RESIDENTIAL v
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
�� c sasY.�'3`r'•`a�`
Other land
2
'�'
( )
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
4.
Residential improvements or Annually
Assessed Motile / Manufactured Home
Garage
(5)
-
Other improvements
(6)
:.K�
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line n
(g)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead $
Valuation or 535.000
Slur FonM!!Hift/w't tinssurArORM ZIA
A fltn BY Mil BMW OEnn[t)S'it. ■,. PitratTBm BY nit DEPARBIE4T IF LOCAL CAnER.YMFTT FDeA CE IC V1.1-ra
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
more beneficial,there is more incentive than e'er for homestead fraud.I lomesread fraud causes higher tat bills for all:therefore.
HEA 1344-200 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recehe 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 Property Address
Whaley, Ronald D/Cindy P 44 e ( 0
0911 1IWY 56 L
IIA%LI'I ON IN 47640 7
263 �1� l/`(A'///✓/
Ronald D Whaley
2785 E SR 56 State Parcel Number Legal Description
HAZLETON IN 47640
26-05-57-078-003.214-017 009-03214-00 PT MD 78 FOR RES 1-10
4.11 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
Owner First Middle
e Aia Q .. �}/� L K Last
fie
Sie Address(number and street.city,state,and ZIP code) Oriarne as property address
2785 i S /? S( //e ztErav _ jz it 7Gyo
Spouse First Middle Last
c ,'," 6y uJfi Li- y
Mailing Address(Number and street,city,state,and ZIP code) El Same as property address
7 8,s' g s� s1 Ain zLE7?,AJ v1 `-/ 7(0q0
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.
Outer I Signature
j GAL Date
PART 4:ADDITIONAL INFORMATION