Homestead_MillereE 4 CLAIM FOR HOMESTEAD PROPERTY TAX:
CREDIT /STANDARD DEDUCTION,
., State Form 5473 (132 / 5 -92)
INSTRUCTIONS: See reverse side for filina instructions.
5tf' U 0 N50
_ - - - CERTIFICATION STATEMENT° - - - -
certify that a*
�) c(We) as our principal place of residence the following described real prdperty for which -a Homestead Property Tax daimed:
I (We) owned ❑ Are buying under contract
❑ Have 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
To hi
n�
W.SI""�
T ing Irid dry, town, , wnship) -
Parcel number
Legal descd
ion _
S La
It any portion of the residential structure or the land not exceeding one (1) acre that ediately 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 Township
County -_ Township
�eby certify the above statements are true, correct and complete.
Signat re Id ant -
Address (number and city state. ZIP code)
sheet.
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL.
VALUE -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
-'
Other land
(2)
Total land (line I 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)
(S)
1 hereby certify the above is true. Correct, and
complete.
Signature of Assessor
Date signed
wing action - Signature of Auditor
Date signed
19 _Pay 19_
Lesser of 1/2 Homestead
Valuation or S2,000
Signature of
j
StATE roRM!MVO IM-t.NM1 TREASURER FORM 73-!A
APPRtna'EO BY"Rif BOSH OF A(mW.75.2U. PRPf1Bm BY IDE DEPARTMMOF LOCAL COVERVMntr EC:.KE M 0-1.1-_LI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple are limited to one homestead standani deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
S HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifyin_ information necessary to allow county government to better monitor homestead
filings.This information will be kepi confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tuXs that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
1101.441,4),_ Miller, Gina A
_ 202 E Mill
Patoka IN 47666
81
Gina A Miller
202 E Mill State Parcel Number Legal Description
Patoka IN 47666
26-04-24-300--0000.212-020 018-00212-00 FISHERS 2ND ENLG 6PT
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
't 110. Qrv\c\ e.QV,\1e`
Address(number and strt.city,state.and ZIP code) Same as property address
,ng
o. 3 oX 6a R a_A-0 k ci Z•U 41 (s). IA LP
Social Security Number(last 5 digits) Driver's Licensc/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
C9DSsS s. / 73 -7 co
Spouse First Middle Last
Sc b+-+ ---bel_,Oakne -,j)- ec\< nue
Mailing Address(Number and street,city.state,and ZIP code) ❑ Same as property address
p.o ,3ox Caa. RcLA-o\< at u Li'7111lci_L()
Social Security Number(last 5 digits) _LA/
Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
g _lylo s� cc 9a S6 _ __
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 Telephone
PC --e.I2J\ L{-9-/0 (gla.) "2-'9 -Ss a 9
Spouse Signature Date Telephone
1 2 , b 4-9 Icy (8R-) "7 -29 -ssz9
PART 4:ADDITIONAL INFORMATION
7