Homestead_JaquemaiWE
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2 i5-92)
INSTRUCTIONS: See reverse side for filing instructions.
STATEMENT
FORM
HC10
YEAR
9 5-
v
I (We) 1 1�`)_ 7KK.�� certify that on the 1st day of March, 19
I (We) occupi d s our principa lace of residence the fo IOFri de ribe r al property for which a Homestead Property Tax Credit is hereby claimed:
tale) 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 propeitybr is btrying ontler at tract.
If buying on contract. Fee Simple owner's name 1.100
I Recorders office where contract is recorded Rdfard number A4 /h , _ .Pane
` PROPERTY DESCRIPTION
County
Township
Taxing d
Irict (cr town, r nship) "
610% bar 1 O 1/x.11" I(1 A _ o 0
Legal des iptio p� / c;)- ^ 3— � 3 3
It any portion of the residential structure or the land not exceeding one (1) arse 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 Townshi
u
Township
5
I hereby certify the above statements are true, correct and complete. Sjgnature of claimant
essss (number and street. city, state, ZIP castle) \
ZQN. If I 3 A O warn W : I d: C, y
ASSESSOR USE ONLY -
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line I 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 plls line 7)
(6)
I hereby certify the above is true, correct. and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
NW STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1i2 Homestead
5
Valuation or $2,000
Signature of Auditor
Date si ed /_
J
M
I
Snit mKstflN oe P.-JO ttLAN[EA RORV mu
.AITRovED DT STATLMiRDf1r Anrotrals_ZoN PAFAAIBWBY Tilt DVARME4TOf LOCAL CU\2L'AUT7 FIANCE ICLI.I-`4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to or homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e'er for homestead fraud.I Ionmeseead fraud causes higher tat bills for all:therefore.
S HEA 1343-2009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to receive a the
benefit and to provide additional identifying information necessary to allow county genemment to better monitor homestead
tiling.This information will be kept eonfdenial and can only to accessed by authorized county o feints.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Jaquemai, Jerry R/Dorothy L
RI Box I13-a
Owcnsville IN 47665
5738 /
Jerryr R//Dorothy L Jaquemai
69 0 S 1500 W State Parcel Number Legal Description
O nsviile IN 47665-8803
26-16-22-200-001.986-023 008-01986-00 PT NE 22 3 13 3.00 AC
' I o I t I I nt I I nI II Ir I r1 I I I leII II
D-18-20
PART 2:TAXPAYER INFORMATION •
Owner I First Middle Last
1 Obhi, 141U_nu.ct I ►9-rt-- c�aC(l,(.eim(..
ng Address(number and street,city,state,and ZIP code) EI Sere as property address- _- `— -- -—
Gino 5 ROD ti1/4-)
Spouse First Middle Last
CUL—Sit LEI n n - Pn r■ JQCi
Mailing Address(Number and street- ity,state,and ZIP code) Same as prope4 address
QGf0 ' soot()
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 Signature Date
PART 4:ADDITIONAL INFORMATION
•