Homestead_ChannellRr j CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION 1
State Form 5473 (R7 / 544
Prescribed by are Depatrnent d Local Cave mier4 Frerve
INSTRUCTMW S- See maven— skin f v finnn inclnw -Jane
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(Wa) ._. .... cerfi(y that on 4V10:1f , 20_
I (we) as our principal place of residence the following described real property for whirl, a Hornestead P eQVMWhd**iQVned:
I 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-
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Reel ror arty ❑ Mobile home (LC. 61.1 -7)
ff arry/portion of tha residergial
or Me lad not exceeding one (1) acre that wmadiately surrounds that
is used tD produce imrre, degc be the use and pardon
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I hereby certify One above staterna is are true, correct and complete.
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ASSESSED VALUE
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Land not exceeding 1 (one) acre imnedalely
surrounding residential improvements.
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1 hereby certify the above is true. correct, and
Sigrrative of Assessor
Irate signed
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Varfyirg arAm - sgnetiaa dAUdilnr
Date signed
STANDARD DEDUCTION ALLOWANCE
qW 20_Pay2O_
Lesser of 12 Fkm estead
Valuation or $35.W0
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Signa4ve of Auditor
Dale steed
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STATE FOAM 43AI R_/YNI
N MEASURER FORM TS-IA
AFPMTEI By SIAM NH4OOF ArYralNTS.Y/r PRrrRIBED BY THE DEPMnMGVr(F LOCAL GO ERNMETI FINANCE IC 6-1.1-"4i
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 et er for homestead fraud Ilomestead fraud causes higher tax bills for all:therefore.
I/ 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 infomlauon necessary to allow county government to better monitor homestead
I ,
Local This information will he kept this information and can only h:s thaaccessed by authorized county officials.The Department of
F YNNO Local Government Finance will use this information w create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
1010 Taxpayer Name Property Address ))
APR 1 2 Channell,James L/Terri L 7070 3 0(4 A o ,,red
‘ //,/. Po Box 357
'a Patoka IN 47666
6.431$0W COUNTY AUDITOR
James L Channell
720 S Old Patoka Rd State Parcel Number Legal Description
PATOKA IN 47666-9003
1111111FFF1,11 tt111t IF 11t11F1,F11F,F11 11F FF 1F111 FFF 1Ft F11 26-04-25-400 018-00555-00 PT SE 251112.20 AC
0--000.555-020
PART 2:TAXPAYER INFORMATION' --
Own.er I _,,, First Middle Ci II WU Last
,.Asa (number end=treet,ci
ty, tate,and LlPcodc)- E'Sewc,,plaperty addES; - -: — _ ._ —.__—.
J 720 D 4 P - C >
: iS K 7‘
Spouse % First L. Middle e /^ /^ ;/ Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
PART 3:CERTIFICATION /
`--Each undersigned certifies,under penalty of perjury;trim the above andtimeguin informatinti ivirue auu or recrand-t:auheor she-is-eligible-to——--- -
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unla/ ,he or she may be liable for back taxes and substantial financial penalties.
Own r I S nature Date
PART 4:ADDITIONAL INFORMATION .