Homestead_Chamberlain (3)4R rr�n YEAR
1: CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
` State Forth 5473 (R5I 10-01)
Prescibed by the Department of Local Government Finance ga
INSTRUCTIONS: See reverse side for filing instructions. N
11
�F- :�L�i -��,x„ ter• =~�. ri..°L �.?'.- _�'. "rF... ���.. -'SCE FICATION STATEMENT;? � �. ,. -r:.•, -T:�'.. - -3nnn9 .... -l.:. 1. `.�_ -- 1.
'ir) occupied as our principal place of residence tK following described real property for i
l(We)owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property
that op (ha 1st y 0 arch. 20
/ IRItS,
}ope Tax Cr 0 i ereby claimed:
GI§' Gy CGM`1 y AUDITOR 1
that owns the property or is buying under a contract.
_ _,>�t'."i'.,�att .�f`�.t_"����- �Cv'%?4 -, z.�xCONTRACT'RECORDED -.,?; � ,.r'..s2. -.� S:. n. a- d- �"�'._- ��i.�51.��'= .�tr�.• - %Y „z :.
�r�-.m �i?.r��� 54 � x �, � $7 -_ „r F`5E ^ � ,>ti-'v" �- t •n
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
:<".. �w-'.. w.'.' J%-' wc`,? P, ROP, ERT, Y: DESCRIPTION4i '-,.J0`Y�.s£ ?u.,?^;`r•�: #,l• i.g'1'
r` r:'.` r`•
:: ?.,`as. -ts�'
County
Township
Taxing ist c (city, to , towns
Parcel number 11
Le description
Is the roperty in question:
—VV / -
9O
Real property ❑ Mobile Horne (I.C. 6-1.1 -7)
ff any portion of the residential structure or the land not exceeding one (13Acre that imAe4sately
surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
"gPROP,ERTYOWNEDFBYCL4IMANT IN`6THER'COUNTIESr'
County Township
County Township
I hereby certify the above statements are true, correct and complete.
ature o laimant -
address (number and street, city, state, ZIP code)
y r s'>¢aG'``""` 1'z -
ASSESSORUSE ONLY
`� "�..
.TRUE TAX%
ASSESSED VALUE
_. :
NON2ESIDENTIAL'f' -
t`• 9g•.
+
':h'... •..f#
OF {TTV,.;
zHOMESTEADq
VALUE�.fi
VALUEr.;`'acY,_
.��.N.w Ni i�.,... n.''��VAL_UEy�
�z
,ATg700Ye
Land not exceeding 1 (one) acre immediately
surrounding esidential improvements.
9 P
X,.. --�" ?•..�+ ice-.
Other land
2
Total land (line 1 plus line 2)
(3)
{v C;4SR
Dwelling
(4)
a
�ti �€�a,r.::a_:Lziws8+'x'c.S�`A
Residential improvements
Garage
(5)
��ivi 5 Via$
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 phis line 7)
(6)
hereby certify the above is We, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
- rash,° ''1�,• i•
200 Pay 1'x_ Pay z r- '�ff, Y '
STANDARD) DEDUCTION' ALLOWANCE-�;.�-'i»:�r'?��.,T�- `,'4',.�-
20
Lesser of 1/2 Homestead
Valuation or $6,000 $
Signature of Auditor Date signed
MTh FORM!JW IICf s■ ■ IRR SUPIA FORM:}IA
Aft :tD BY STATE 110.3113(IF AcTTR.'R.Zion rtF3tIhm BY TEE DEPARTMENT OF LOCAL GOVERNSWICr ITKPOZCZ IC 11.1-224.1
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
more beneficial,there is more incentive than emu-for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 134-1-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to teethe the
benefit and to provide additional identifying information nemary to allow county government to better monitor homestead
filing.This information will be kept confidential and can only be accessed by authorized county officials.The Depannlem 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
Chamberlain, Patricia Lynne
Mill S'i'
Patoka IN 47666
133
Patricia Lynne Chamberlain
P O Box 214 State Parcel Number Legal Description
Patoka IN 47666-0214
II III I I II II I I uIII ' III st III o I 26-04-25-101-000.457-020 018-00457-00 BARNES ENLG
nu
t o tot tit to n t 1 1 t o tit 1 t _/ 9OPT/91/61PT
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
?ft t—g ► Lt LiA/ g a orb er /a,t ,✓
ling Address(number and street,city,state,and ZIP code) ISame as property address
/021WmILL Sr ?rf-r-ok'A IA) 4-7 la (oro
Spouse First Middle Last
/V 4
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
•
_ sore
PART 3:CERTIFICATIOA — '---�--- -
. Each undersigned certifies,under penalty of perjuy,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
•