Homestead_MaceCLAIM FOR HOMESTEAD PROPERTY TAX FORM fWEAR
CREDIT/STANDARD DEDUCTION
State Form 5473 (R5110 -01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
S CERTIFICATION STATEMENT
�
SEP 3 2002
1 (We) certify that on the 1st day ofMarch, 20
1 (We) occupied as 01-incipal place of residence the following described real property for which a Homestead P arty Tax I ts, reby clWed-
Is
❑ I (We) owned ❑ Are buying under contract
GABi,
alHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prope y i ji,�d Vqra"
,4 9
—CONTRACT; RECORDED
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
`OkCiPtFiTY.bWNEDBYCLAIMANTINOTHER'COUNTIES�'--,'--,"n" •
County
'PROPERTY DESCRI -J-
Cou?'O
Township
I hereby certify the above statements are true, correct and complete.
T ngrkicll tfZywn
6 L4
`mss Z t
ASSESSOR ig ?
b
TRUE TAX
'VALUE,
Parcel nupoer
g description
Is the pro shoo
Valuation or $6,000
q: pro
I 7R party ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the 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.
Land not exceeding I (one) acre immediately
`OkCiPtFiTY.bWNEDBYCLAIMANTINOTHER'COUNTIES�'--,'--,"n" •
County
Township
County
ship
I hereby certify the above statements are true, correct and complete.
Signature
_atuM re of claimant
,7�gr a o
`mss Z t
ASSESSOR ig ?
b
TRUE TAX
'VALUE,
ASSESSED NALUE
HOMESTEAD
,.NOWRESIDENTIAL
,
Valuation or $6,000
AT100%o m.
V AL LIE
Land not exceeding I (one) acre immediately
Date signed
surrounding residential improvements.
Other land
(2)
Total land (line I plus fine 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, mmect, and
Signature of Assessor
Date signed
complete.
I
Verifying action - Signature of Auditor
Date signed
STANDARMIDEDUCTION ALLOWANCE
20_ Pay 2O—
Lesser of 112 Homestead
Valuation or $6,000
Signature of Auditor
Date signed
STATE FORM:We.,Rrt,.M, TREASURER FORM 71-1A
.APPROVED BY Sr.r£NMkD Of'∎CMi.'r(ryrr PREARIREDay MC DEPARTHEST OF LOCAL ros20.MM£rr FeeAwc£MFI-1-_JI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple are limited to one homestead aandani deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ncr for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344--3009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
tiling..This information will he kept confidential and can only he accessed by authorized county officials.The Department of
Local Government Finance will sec this information to cream tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Mace, Larry W/Michelle G
105 W MILL ST
Patoka IN 47666
132
Larry W Mace
P O BOX 111 State Parcel Number Legal Description
PATOKA IN 47666-0111
IrI1tllttrlrllt rrl'rrrflee ll Ilrrrllrttilttt llt rtlitilt tl 26-04-25-101-000.443-020 018-00443-00 PT NW 25-1-11 .so AC
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
Cxrc VZt\\yam cc-NC3,CQ
012 Add (number and street,city,state,and ZIP code) ❑ Same as property address
\— ' bX \ 1 \DS \s MA\ s t
po First Middle Last
)che-A\2— Csi\be-CA cnaCQ
Mailing Address(Number and street,city,state,and ZIP code) ❑Same as propene address
(Db. S) sx C�111 1 \ 5 O n-\\\\ .\il2q.t)
•-- -—
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 1 S' ature Date
PART 4:ADDITIONAL INFORMATION
0
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