Homestead_HerrinCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R13I 12-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS., See reverse We forfift instructions.
FORM
HC10
FIT 1p
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residence place of real property fw which a Homestead Property Tax S e- is hereby claimed
Oer contract on the date this appli�tion is filed, (date of filing)- I (We): C 2� .12
Own E] Am (are) buying under recorded contract
■ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation GIBSON COUNTY • •-
■ Have a beneficial interest in the trust or the right to occttpy the property under the terms of a qualified personal residence trust
■ Am (are) the shareholder, partner or member of the entity that owns the property.
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•�'i° s> '9. s:rzii ;" -?'r .= tc�'. .`$°d�'Ji CLAIMANTS.Ni"611MAT10Ni s.Sei i. ..sfr�.L r4s"." �t.T".-°.�aCz1 .i .eAF.'z v'c.�...z�'..
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of claimant (last rwe digits)
/Other
of clatmant's spouse (last five dorls)
; OACTRECORDEO
yiaF NTR
If buying an conuact, Fee Simple ownees name
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t.I1s.:ERTY'DESCRIPTION�v
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C'':Y °PROP,ERT.' OWNED.. 13Y.CLAIMANT:;IN OTHER'COUNTIES %y ,�!ge'+t.3yS >+s ..?.. ~z.;!
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ti?v',"'•' ASSESSOR USE ONLYfy i't Au+ IiYjTRUE�T
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®�AT.100—
ASSESSED VALUE' ^"''HOMESTEAD `
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ON- RESIDENTIALf�'� tt
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20 20 Lesser of .t% of the assessed value of the homestead rrt
Notwithstanding any otharprovision, the surn ofthe deductions povdad in IC 6-1.1-12 to a niobfle hone trier is
not assessed as rearrperly or to a rnanufactured home that is not a�ssed as Mal PraiaertY MY not exceed
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R1,1,15 W,C r41•P 1R:A[IR[1l tMLU 151.5
.VrtOvEOOY:l AIE csiwn OF I rnrs .w PRESCRWmn\rHG OVARTML.l of RKtALCm}A'MLst FL\\ACL IC Fu-2Z4.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N.Main Street Individuals and married couples are limited to one homes:ead standard deduction. AN the receipt of this deduction becomes
Princeton, IN 47670 more beneficial.them is more incentive thin ever for homestead fraud.Homestead fraud can ms higher ms bills for all:therefore,
IIFA 1344-1009 requires taxpayers who receive the homestead standard deduction m verify that they are eligible to/arise the
benefit and to pros ide additional identifying mtbrmausm neeesiary to allow counry government to better ndnitor homesead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to cronc tools that will help county officials eliminate homnteatt baud.
PART I: PROPERTY INFORMATION-
Taxpayer Name Location Address
Herrin, James R
514N150W
PATOKA IN 47666
477 ��I II
James R Herrin II I III[1II II-II Inn u �IIIIIIWII II1OII Ill II1 IIIDIII_ IIIII111IIlhI-IDIDIIi II ..y.
1133 S Prince ST
PRINCETON IN 47670-3011
1I1IIII'll1lltlltl1tll1'1IIII1III'11'I1"II1III11IIIlIll'Ill'II'I State Parcel Number Legal Description
26-04-24-300-000.375-020 COL DIV 3PT
FILED
MAY ,9 2012
-This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment ?&inceent§iig surer.
:ilrAll�,vvwtl:alAxentrolso]a
a ;r Fiat Middle Last
, 5 Boma rd Sri (1
Mailing Address(number and street,city,state,and ZIP code) [] Same as property address 0
Spouse First Middle Last
Mailing Address(Number and strut,city,state,and ZIP code) Same as property address
.SOc /S^a
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 Signature Date
st Signature Date Telephone r l
PART 4:ADDITIONAL INFORMATION .