Homestead_Mason SIVE roRN!J!MIR/wn TREISUILR Po0.41 TS-IA
APPROVED BY MATE RWID(K.M�YR'T�.m• PAEAAIBID BY THE DEPMMENTif LIXAE roac0.VNrT7 FQ:&SCE r i.IIIJI
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 e'er for homestead fraud.Homestead fraud causes higher tat bills for all;therefore.
HEA l344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing..This information will be kept confidential and ran only be accessed by authnri,ed county officials.The Depanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Mason, James E/Janice
512 S Old Patoka RD
Patoka IN 47666
621
James E/Janice Mason
512 S Old Patoka Rd State Parcel Number Legal Description
Patoka IN 47666-9001
I I III I I I I I I I I I I
1111111,1111111111
26-04-25-104-000.396-020 018-00396-00 PT SE NW 25-1-11 3 AC
r u nt r ut nt n o n rn
PART 2:TAXPAYER INFORMATION
•Owner I First Middle Last
6A-R L m A-so Af
�ng Address(number and street.city,state,and ZIP code) - rty Same as property add. ;
5/ 0 ) PA To KA- Rb -P/1-7-"O np AO
Spouse First Middle ( Last
( C•• LE c9/ S c fl-S-o JJ
Mailing Address(Number anti street, Af elet,city,state,and ZIP code) Same as property address
E
- — -- -----
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 Si_naturc Date q ✓ / Date /
PART 4:ADDITIONAL INFORMATION -
I
CLAIM FOR HOMESTEAD PROPERTY TAX
a, CREDIT /STANDARD DEDUCTION
Y� • State Form 5473 (R2 / 5 -92)
uu
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10 OQ
CERTIFICATION
STATEMEM;;..
I (We) certify that on the 1st day of March, 19
1 (We ccupied as our principal plat of residence the following described real property for which a Homestead 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 owns the p rt*,Tbuy 1n r contract.
_ -- CONTRACT RECORDED; _ r,?..:. -' 1,�•?e,,
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded �, , rd_KAbery : ! tp(TOR age
.PROPERTYDESCRI
County Township .
Taxing or tri
( ,tow to p)
NON - RESIDENTIAL.
VALUE .
reel io 03% ^ ^ �egal description
If any portion of the residential structure our 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County
ASSESSED
VALUE.
County
NON - RESIDENTIAL.
VALUE .
I hereby certify the above statements are true, correct and complete.
alur of claimant
T (nury wr and sn dry. state. zlP code)
' ASSESSOR USE ONLY •
TRUE TAX
VALUE,
ASSESSED
VALUE.
HOMESTEAD
VALUE
NON - RESIDENTIAL.
VALUE .
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
-
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
I Date signed
Verifying action - Signature of Auditor
Date signetl
- - STANDARD DEDUCTION ALLOWANCE`
19_Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
Signature of Auditor
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