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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for fifinq instructions.
FORM YEAR
-! Ifi 11 v- i ;1
JUN ZI 2004
(We) Lkq/) �' "�"�'��L cerfiN,that owthe s, t aay of Maft, 20'
II((Wee)) occupied as our principal place of residence the following described real property for which a Homestead Proopery Tare Credits hereby claimed
b'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.
eCONTRACT,RECORDEDt
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
h:rt -vac' eY;3
t�- �'��`.t- c�'f`,r._.i.r, .x"�'.tt �e+z`�'
'g-: -:"�^f - r'____. - _— _ _ '� ! -
�' ma��F.. �..? P, ROP, ERTY. DESCRIP. TION. ��., �`' ��?�t`= �-�"�`'= ��,:�:+�'r�= �;.,c�dfst �"y�`�.�?���,_?
County
Township
Taring" ist' 'ty, town, t wnshtp)
'
Parcel number
V
Leg descri 00 / ,
L
Is the property in question:
eat property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (7) aae that immediately surrounds that s cture la used to produce income, describe the use and portion
of the property utilized to produce income.
'- ' PROP, ERTYOIN NED� ;BY�CLAIMANYIN,'6THER`COUNTIESb
County
Township
County Township .
hereby certify the above statements are true, correct and complete.
Si re df claimant
6dress (number and street, c N state, ZIP code)
-
T ASSESSOWUSE ONLY x z� -
TRUEaTAX a
�,
ASSESSED,VALUEHOMESTEOJ
NON = RESIDENTIAL
�[
_ 'Y
VA_L_UE
#AT.1000%'0FFVµ
VALUE +
VALUE..tz
Land not exceeding 1 (one) acre immediately
1
()
;�xT"
surrounding residential improvements.
'f� rv3r.,�
x
-,
Other land
(2)
ny3s
a ��
». Qi
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
('-
Residential Improvements or Annually�`"'G4```.^�'
Assessed Mobile I Manufactured Home
Gana g,
Other improvements
(6)-
5
%''' -`I'
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
I hereby certify the above is true, correct. and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
Tit'�:STANDARD: DEDUCTION` AL10WANCE
20_Pay 20_
Lesser of 12 Homestead $
anon or 535.000
S re of Audit I // Date signed
lit �/ �•r,- Gt- i`!'/� —_�
STATE FORM''sic/. r TREASURER FORM 11-IA
APPROVED BY STATE.BOARD OF MTYI.\tS'_vM MUFSPIBED BY THE DEPARTMFYT or LOCAL rAVERYMEFT FINANCE ICVl.1-r.si
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 esrr for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
�
' ,� b1F.�1344-2009 an tprovide ovide additional taaonal identifying ying in the anon ewe standard sry to deduction cion to cover that they are eligible
ni t�newe the
benefit and to rw'idr addiaorlal identifrim_ informanun necessary to allow county'em'rmment to better monitor hotresead
filings.This information will be confidential and can only be accessed by authorized county officials.The 1 nrnt of
local Goverrunent Finance will use this information to create teols that will help county officials eliminate homestead fraud.
APR 2 1 2010 PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
777?N
/� Nulton, Homer/Fern \�
Cherry ST
GIBSON COUNTY AUDITOR
PATOKA IN 47665
11
Homer/Fern Nulton
P O Box 68 State Parcel Number Legal Description
PATOKA IN 47666-0068
1t1tt11tt 11t11rrt11 ttt11tti1tt tilt trt 11rt1t t1tt11tt1tt1ttt11ti 26-04-24-303-000.004-020 018-00004-00 COL DIV 4 PT/9 PT
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
Meiling Address(number and street,city,state,and ZIP code) aj name as property address
t o. i% tee - /2c/ zi to/ 4
Spouse /,, p n ., y(� a JI . First Middle Last•
Mailing Address(Number and street.city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Slate
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
unlawfillly,he or she may be liable for back taxes and substantial financial penalties-
Owner I Signature Dale
Spouse Signature Date Telephone r l
PART 4:ADDITIONAL INFORMATION