Homestead_BlaizeCLAWFOR HOMESTEAD PROPERTY TAX FORM vEAR
CREDIT/STANDARD DEDUCTION - HC10
State Form 5473 (R614-03)
Prescribed bed by the Departinent of Local Government Financa
INSTRUCTIONS., See reverse side for riling Instructions.
I (We) %_-4V.XA_V_VW,, 1 N -T I I I C#O th 1�s Dda, o at '20
a
I (We) occupied as our principal place of residence the follo%u descjibed r which a Home4ad P, i is
real props LoA stab'' -Fsainted:
I (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 the property or is buying under a contract.
If buying on contract, Fee Simple owners name,
Recorders offloe where contract Is reoorded Record number Page
Pill 0 PE R T.* D E S C R I P T 10 N,� 3V
W,
County
Township
I hereby certify the above statements are true, correct and complete.
Taxing district (city, town, township)
ress; (number and street, city, state, ZIP code)
Parcel mbar Int,
_ 603U-M
n-
IMW Ike
$
Is the property in question:
(1)
te signed
M
❑ Real Property
❑ Mobile Home (I.C. 6.1.1-7)
If any portion of the residential structure or the land r
i
y surrounds Pndq that structure is used to produce income, describe the use and portion
of the property utilized to produoa Income.
Other land
(2)
OTHER7COUNTIES:�!r,��i.,,'.--'(��-,
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
ress; (number and street, city, state, ZIP code)
e.a, ASSESSOR USE ONLY
�T4'ei_V
Wgibisb iAL'6_i_
HOMESTEAD'-.
��i NOWRESIDENTIAL"�'_-_�'-'
N
ftT100%
VALUE'. A
$
Land not exceeding I (one) acre immediately
(1)
te signed
M
surrounding residential Improvements.
37' v -6) S�
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
improvements
(6)
,,�Iter
Total improvements (line 4 through line 6)
(7)
Tdal value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Ventymil action - Signature of Auditor
Date signed
PM1 �l�-,� STANDARDDEDUC110N!ALLOWANCE-. •
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or $35,000
$
Signature of Aiditor
te signed
M
37' v -6) S�
V %J
............................................
i.
e
STATE FORM 539.,W/'-Ib 1R:ASU RIR FORM IS-LA
APrvIED Ill CE%IF VIRO OF Al U P.IS.Tf /SYNC PLIED BY THE OLPARIYETOI LIX:• tlnIA%mOSTlxVKE wb1 "{.t
Gibson County Auditor • IMPORTANT NOTICE TO HOMESTEAD.PROPERTY OWNERS'.
101 N.Main Street Individua6 and married couples are limited to one homestead standard deduction.:As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,Mere is more incentive than ever for ho nmtead fraud.4omnread fraud causes nigher tax bills for all:therefore.
• IIEA 1344-200 requirs taxpayers who r ceive:he homestead sundarJ deduction to serifs'that they am eligible to receive the
benefit and to protide additional identifying information necessary to allow county government to better nnnitor homestead
' ' 6lirp.Thi information will be kept confidential and eau only be accessed by authorized county officials.The Department of
F
F Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION"
Taxpayer Name Location Address
MAY 18 2012 Blaize, Charles K/Mindy M
207 E MILL ST
c. .m `
PATOKA IN 47666
GIBSON COUNTY AUDITOR
C harles K Blaine IIIDIIIII1DIIIIIIII IIIaIIII011111II IIIIIQIIIII]IIIIII1 IIII[IIIIIJIIIII II
2404 E Lake Rd
PRINCETON IN 47670-8941
IIIII'111II1III11I11"ICI'1111"1I"II'I"+I"I'll11llll'lll"'l State Parcel Number Leqal Description
26-04-24-304-000.385-020 COL DIV 8OPT
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.
9 • •• • PAR 2: A:PA II V , O` - .
.er I 1 First `/ Middle 11 Last
C 11Q(\e5 �e,�h ld»Q
Maillin_Address(number and street,city,state,and
-1ZIIfl'c1oode) I ,, ❑ Same ass propene address i}\\
1 .0• &X O-� '' PC A-0 K , , 1 Ni r ��G G W \Q o , M A I S 1 . 1
Spouse First Middle Last
IV\In(iLl Me\ tssa 310,I
Mailing Address(Number and street.city,state,and ZIP code) ❑ Same as property address
— -?,0.9,0 Vc,�` `4c` 6 1-11— 4� plp c�01— =: M-tll � > -- --- -
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 Sig lure Dare
PART 4:ADDITIONAL INFORMATION- ' .