Homestead_FryrearCLAWFOR HOMESTEAD PROPERTY T AX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614.03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instaxtions.
(We) 4u 1 V" I V 1 11 VKxAC4YqCF
DOCUP' Tas our principal place of residence the following described real proAky 1 r which
I Zed ❑ Ave buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and t
FORM YEAR
HC1 0
on the lit da' '�arch, 20_
era N63ad! I is hereby claimed:
rA6W1:rbuvinq under a contract.
If buying on contract. F" Simple owners name
Recorders office where contract Is recorded Record number 1Page
4 1 1
IVIN
County Township
County Township
County
Township
Tearing district (city, to", township)
U 1�
AL
Is the property in question:
Vrm-T.3.
I ❑ Real property E3Mobile Home (I.C. 6w7. 7-7)
If any portion of the residential structure or the land not exceeding we (1) am that eyediaftely surrounds that structure is used to produce incorne, describe the use and portion
of the Prop" Utilized to produce Income.
(1)
(j!kYMJP9 0400ERTY.dWNEDIBY,CLAJMAf4TtfWOTHER—CbUNTIES�, F'V-�r
County Township
County Township
1 hereby certify the above statements are true, correct and complete.
Signature of claimant
'cress (number and street, city, state, ZIP code)
0 DEDUCTIOWALCOWANCEf�:
20 _ Pay 20
Lesser of 112 Homestead
Valuation or 335,000
Signature of Auditor signed
IaAm= 8 Date 0�—)
U IJ r
7%- R
ASSESSED YA-LJ* E'-
��HOMESTEAD, - -
,
" ;'; Nz
ESIDENTLAV�-v
ONA ,"
U 1�
AL
"5 k
Land not exceeding 1 (one) acre immediately
surrounding residential Improvements.
(1)
Other land
(2)
i;v. 7�7
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
2N
0't
.91ger improvements
(6)
Total improvements (line 4 through line 6)
(7)
Taal value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
0 DEDUCTIOWALCOWANCEf�:
20 _ Pay 20
Lesser of 112 Homestead
Valuation or 335,000
Signature of Auditor signed
IaAm= 8 Date 0�—)
U IJ r
• SIAM fORM!Iw t1C1 wn TREASURER FORM IIA
Arramen BY MATE WARD Of MT7R--srszIM PRESCRIBED BY TIE OEP.MRMEYr OF LOCAL r ER:MIX'T Fe&scErct.l.t-r4I
Gibson County Auditor
107 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 ncr for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires axpaycre who receive the homestead standard deduction to verify that they are elicible to receive a the
benefit and to provide additional identifying information recessary to allow county gosmment to better monitor homestead
filing.ibis information will he kept confidential and can only be accessed by authorized county officials.The Depanntent of
Local Government Finance will use this information to create 4e3ls that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
_ Taxpayer Name Property Address
Fryrear, Kimberly L
409 I'
Patoka I@ 47666
616
Kimberly L Fryrear
409 W 1st St State Parcel Number Legal Description
PATOKA IN 47666-9015
�t�tt��ttt�t��ttt��ttt��tt�t�tt�� ��t�t�t��trtllltt�tlt�� 26-04-25-103-000.321-020 018-00321-00 COLEMAN ENLG 1 PT
PART 2:TAXPAYER INFORMATION
Owner I First Middle �- Last
•
�trD,IrI-e- n n I-t— t�Ec�
to Address(number m1 city,state,and ZIP code) — —— — - --- —-� Sara prupeny nidmesa - - -- - -—
Spouse First Middle Last
Mailing Address(Number and street,city,sate.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 Pan 4 below)
Stec
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 ignature '' nn "" /) Date
Spouse/Sigtamre t1 x U Date Telephone
•
PART 4: ADDITIONAL INFORMATION
•