Homestead_GriffinIN
.V" � EM
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
State Ferro 5473 (R715-W
Prescribed by the Deparbrient of Local Covemiment Pn
INSTRUCTIONS: See reverse side for Ming instn di ns.
YEAR
'PV ED '
4 1.:CWM"MOI1`I
I (we) certify that on the I at day of March, 20
I (We) occupied as our principal place of residence M "ng descried real property for which a Homestead Property T% Ad 06W�Pamnad-
owned ❑ Are buyrng under contract GIBSON COUNTY AUINTOR
Have a beneficial interest in the entity Met is liable for the property taxes on the property and that owns the property or is buying under a contract
CT C EW! -49 ,`:
ONTRA RE ORD
If buying on contracL Fee Simple ownees name
P"order's dke whoe contract isrecorded Pjx:nrd number Page
i. �eiAA�ORUSE
-4,:: PROPERTY 0 ESCRI FD*,
Coultry
Township
County
Taring d- town. I
Parcel rKffnber
Im! dpaxnard
alu re
%,MALUE
IS the property m question:
9bilrew tnumber and
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W"30/ 'f�" ,
Real popery QMob[I. H. (I.C. 6.1.1-7)
sbucture cur the lad not mWeecling or%
(1) acre that immediately suffourKh Met stint re m used to produce income, descirbe the use and pa tim
dff� =W0ff*.—d=w.X Income.
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a & - 0 '4 - � 5 - /o/ — 6 0 0,
ono
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County
Township
County
Township
I hereby certify the above staternents are true, conect and cornplete.
Im! dpaxnard
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or
9bilrew tnumber and
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Lesser of 12 Hornestead
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dki
VALUE
-;AT 100%z0F
%,MALUE
or
Date signed
n'
Land not exceeding 1 (one) am imrnedabaly
surrounding residential irrip"Nernents.
Other land
(2)
Total land (lame I pt fine 2)
(3)
Dwelling
(4)
Residential trnprovetnents crArtrually
Garage
Assessed Mobile I Manur!actured Horne
(5)
Other improvements
(6)
4-�
Tdal utprovernents (fine 4 thrmigh One 6)
(7)
Total value (fine 3 plus One 7)
(8)
1 hereby certify the above is true. correct. and
mmpleta-
Sigrmture of Assessor
Date silp
Vatlying action - Signature of ALKbtx
Data signed
,i STMDAFtDDEMJCTM ALLOWANCE 's ,-..al�,,�.," -;"!,',.�..
4X
20_ Pay 2O_
Lesser of 12 Hornestead
S
Valuation or MODO
stmt re of xxuw
Date signed
•
STATE FORS'5"F4121YN1 TRE'SL[EA EOM.73-IA
.ArPROVED BY MIT aINPO OfVT[t.TS.NI Po rtnS(Amm BY MY DEYARf WT OF LOL:AI W%tLYMrWt ra:ANCE W.-Li-_-I.I
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 ester for homestead fraud.homestead fraud causes higher tat bills for all:therefore.
HEA 1344-3009 requires tavpavers who receive the homestead standard deduction to verify that they are eligible to reeehe the
benefit and to provide additional identifying informauon recesmry to allow county government to better monitor homestead
filing.This information will he Lepi confidential and on only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate harms:cad fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Griffin, Kenneth A/Kelly
Patoka IN 47566
135
Kenneth A Griffin
301 Wood St State Parcel Number Legal Description
OAKLAND CITY IN 47660
26-04-25-101-000.620-020 018-00210-00 BARNES ENLG 66PT
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
_ KriViVE7N ALPI/Ea s SR�/h u
ills Address(number and street,city,state,and ZIP code) Same as property address
PO •n S &s PAToKA rru 47664
Spouse First Middle Last
1 71
Mailing_Address(N tuber and street,city,state,and ZIP code) [] Same as property address
Po, (Box s& Pq 4a,em 1h 417 0 6 6
Other(please specify in Pan 4 below)
• PARTS: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