Homestead_Keehn_ 1
CLAIM -FOR HOMESTEAD PROPERTY TAX , VFW YEAR
CREDIT /STANDARD DEDUCTION 010 18 998
State Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side for filing instructions..
" CERTIFICATION STATEMENT=
I (We) certify that on the 1 st day of March, 19
1 (We) occupied as our principai,place of residence following cdbed 'real property for which a Homestead Property Tax Credit is hereby claimed:
+
Y1261 (We) owned ❑" Are buying under contract
ave 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. .
CONTRACT. RECORDED .._.-
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
- - - - - " PROPERTY DESCRIPTION
County
County
Township- -
T g dis rict (cit
own, township) _
Sigpature of claimant
- ss (number and street, city state, ZIP code)
y
Date signed
-
Parcel nIu r
Legal descripI
I
'
Total land (line I plus line 2)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surin that structure is used to probuce income, describe the use and portion
of the property utilind to produce income.
.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Sigpature of claimant
- ss (number and street, city state, ZIP code)
y
Ll
ASSESSOR USE ONLY
-
TRUE TAX
VALUE
ASSESSED
VALUE.-
HOMESTEAD
-VALUE
NON - RESIDENTIAL -
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Signature of Autlitor
Date signed
-
Other land
(2)
'
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
-
Garage
(g)
Other improvements
(6)
-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(g)
'
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE '- - - - -
19 Pay 19
Lesser of 112 Homestead
Valuation or S2,000
$
Signature of Autlitor
Date signed
STATE FOtst!lW Ixn 541.1 nIASULIA FORM 11A
APPROVED BY SPCIE IIDSRD Or iCCDUSTS.Zin• PILLSVItIBED BY mr DEFARME4T OF LOLA' L 00•71124MENT FINANCE IV 6-1.1-2:4 I
Gibson County Auditor:
101 N Main IMPORTANT NOTICE TO HO7 STEAD P 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 net for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1314-2009 requires taxpayers who receive the homestead standard deduction to eerily that they are eligible to teethe the
benefit and to preside additional identifying information necessary to allow county goy ermment to better monitor homestead
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 create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Keehn, Terry Ray
310 Second ST
Patoka IN 47666
147
•
Terry Ray Keehn
PO Box 94 State Parcel Number Legal Description
PATOKA IN 47666-0094
26-04-25-103-000.382-020 018-00382-00 BARNES ENLG 83PT/69
t u II t t II rte I I w I I n I I nt II err I r I err I uIIt I err V m I t I t I
__ _ _
_ __—_ — . ` / _.— __ _- __ _ _
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
4ERRy +Rch./ ii-e-hn
ippg Address(number and street,city,state,and ZIP code) Same as property address
3to L3eST or1 5T PA-r-okA- AND y7toLoly
Spouse First Middle Last
- c�rr�- l nI se geeh0
Mailing Address(Number and street.city.state,and ZIP code) El Same as property address
C o u S yoocl S- P frR �D N7& 64
. t 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
461.4 _�'J_i_ _ b.- i L Iii y `� /o • .
PART 4:ADDITIONAL INFORMATION
7