Homestead_KermodeCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Government Finance
ST NIENT�'- �,'�
(We) certify fat on die lst dWdf March, 20
(We) occupied al our principal place of residence the toll 061 g dAcribed real property for which a Homestead ' Properly Tax Credit is hereby claimed:
EI-1 (We) owned ❑ Are buying under contract
Islave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the tract.
2CONTRACT'RECORDEDI"V,-:V,
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
. ry�� , , W. - , 0 itty.6 ESCR
rz PRO E
KOM
CounTy
Township
TaxinkdAtric-
di- y, wn, wrish,p)
f
K'W Q
Parcel number
de ription Is the proIZW.uosp1,,on
-OD
24
41 0- 6,35pj
Perry ❑ Mobile Home (I.C. 6-1-1-7)
ruas
residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
County
Township
I hereby certify the above statements are true, correct and complete.
County
I �dd in uA r
and s� sfat
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NO W SSESSOR-USErONLV,---M"--!k
M TRU E JAX'fii
'ASS ESS ED,VALU E
-AT100%-OFJTV�W�
I.IHOMESTEAD.4
-RESIDENT A
NON I C �1!4f
iwpl
VALUE
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Land not exceeding I (one) acre immediately
N
surrounding residential improvements.
(1)
A
Wr
Other land
(2)
yi
Total land (line I plus line 2)
(3)
Dwelling
(4)
Y4,
SA-
Residential improvements
F.area .
Garage
(5)
MOT
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct,, and
Signature of Assessor
I
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
•
•• stsIE HAM 53'MIM-t WO TILASUILEA 105411A
APPROVED BYMUrIIM11n or MnSLNT;9N PtrffiAmm BYntr DEMa1S2YHi LWLLLCAwi6YSRNr FINANCE II'H.I-)_`E.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to or homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eser for homestead fraud.homestead fraud causes higher cox bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to creche the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kepi confdential and can only he accessed by authorized county officials.The Depannlent of
Local Comment Finance Dill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
• Kermode, Michael/Mary J
RI Box S-h
Patoka IN 47666
639
Michael Kermode
621 S Old Patoka Rd State Parcel Number Leal Description
Patoka IN 47666-9002
��ttt�t��ttt��ttt��tt 11111��Itt��trttt�t�..�t 111111111.11 26-04-25-40-0--000.549-020 01&00549-00 PT SE 251112.699 AC
I tltt
_ _- - . _ _ _ —_ —_ �( _ - _ ___ —
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
t o�/ N-t- A I�. l�� �: -,�ei� i
�g Addfess(number–Ed street,city,start,and ZIP code) t/ rtur as property address
la 21 s "4( Ai?xC, . V
/ /
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjuy.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 Signa...t Date
PART 4:ADDITIONAL INFORMATION
• - v V