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Homestead_HulfachorAte* CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR CREDIT /STANDARD DEDUCTION Hc10 (bZ O J State Form 5473 (R5I 10 -01) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse side for (ling instructions. I (We) U VyTe"' ^, certioifi'dl on the 2004 of March, 20 1 (We) occupied as our principal place of residence the fol & ng described real property for which a Ho stead Property Tax Credit is hereby claimed: ❑ I (We) owned El buying under contract Have a beneficial interest in the entity that is liable for the property taxes on the property and that 1mohio0OW -is btWbTG Viler a contract. .+.r NTRACT.RECORDED0-�1 i..`�i If buying on contract, Fee Simple owners name Recorders office where contract is recorded Record number Page ts`'L%bh :"- `L D "e,. _ -, - _a- -60S .. _.._. WFIWR -MEMW 'k�a); a ?P,ROPERTYzCRIPTION Coun 1 hereby certify the above statements are We, correct and complete. Township Agldress (number and sheet, city, state, ZIP code) Tadng district( n r - �cel pu I/ r ^O /� _ �V g I d dption C J Is the pro ny in question: Real property ❑ Mobile Home ( /.C. 61.1 -7) If any portion of the residential sWcture w the land not exceeding one (1) acre of the property utilized to produce income. t'mmediatety surrounds that structure is used to produce income, describe the use and portion '����'"'`� P, ROPERTY, OYVNED- iBY:CLAIMANT;IN�OTHER`000NTIES County Toxnship County TownshipsK 1 hereby certify the above statements are We, correct and complete. >Nlure of claimant Agldress (number and sheet, city, state, ZIP code) �? ASSESSOR(USE ONLY " a WW3 !*dcs?::?°4r•' yb _ TRUE TAXI, --S ASSESSED VALUE AT- 700 %OFysTTY 3HOMESTEAD VALUE °- NON- RESIDEIJTU \L�..a . >`'TVAI.UE Land not exceeding 1 (one) acre immediately surrounding residential improvements Other land (2) q, land (line 1 plus line 2) (3) Residential improvements Dwelling (4)Y �; b° s' = r -'^''' Garage (6) u DY 0� ;- 5�... -,_. ..`� Other improvements (6)'y=y rt Total improvements (line 4 through line 6) (7) Total value (line 3 plus line 7) (g) 1 hereby certify the above is We, correct, and complete. Signature of Assessor Date signed Verifying action - Signature of Auditor Date signed 15 � � ` STANDARD: DEDUCTION 'ALLOWANCE. -.�".- �- ��3..us.� 20 _ Pay 20 Lesser of 1l2 Homestead Valuation or $6,000 $ Signature of Auditor Date signed H U 44 T1 SIAM FOfli,"Mlle/NNI TRFASUEER MCA'MIA APPROVED BY snit BMRD OF M'rOUNT<__nv PPIYTEBED BY ME DEPMTSncr f*LOCnAL tOVtLYMT T FINANCE IC4I.IS_4.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 ever for homestead fraud.Homestead fraud causes higher tat bills for all:therefore. 41.1 HEA 000 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the benefit t and and t t to provide additional identifying information necessary to allow county government to better monitor homestead filings.This information will he kept confidential and©n only be accessed by authorized county officials.The Department of Local Government Finance will uxe this information to create tools that will help county officials eliminate homestead fraud. APR 8 2010 PART I:PROPERTY INFORMATION Taxpayer Name Property Address ` t 4 Hulfachor, Norman E �0��// 307 w nliu GIBSON COUNTY AUDITOR Patoka IN 47666 146 Norman E Hulfachor 307 W Mill State Parcel Number Leval Description Patoka IN 47666 26-04-25-103-000.166-020 018-00166-00 COLMAN ENLG 5PT — -- 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 n Address an g Addrs(number and street,city,state,and ZIP code) .0 MI Same as property address • 3 0 7 w f ndP Sr* :P Spouse First Middle Last Mailing Address(Number and street city,state,and ZIP code) ❑ Same as property address Social Security Number(last 5 digits) I Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below) 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 Spouse Signature Date Telephone (t/ l / PART 4: ADDITIONAL INFORMATION . . •