Homestead_RavelletteMA
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R5 110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
YEAR
(IWWel certify that on the 1st day of March, 20
'I occupied a ur principal place of residence the following described real property for which a Homestead Property MAYreit 4 h2a2claimed:
u' p
I /(We) owned F-1 Are buying under contract
I
I rHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pt � or i 41
s-",in Linoe Q
9 r a contracO
V� zbNTRA(n�RECORIDIED
If buying on contract, Fee Simple owner's name
Recorders office, where contract is recorded Record number Page
R'lW;W Ev
Rbnkry- �'k
972'y
04-0?6- q00 "LOWW'STLI
Toomship
-o Dr.,
distri
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Signature imam
Legal description
Is the property in question:
5 W-00
��VALU
AN -47 —W RPM
;eat property ❑ Mobile Home (I.C. 6-1.1-7)
If any Portion of the residential structure or the land not exceeding one (1) acne that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
R'lW;W Ev
County
Township
I
County Tmnship
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I hereby certify the above statements are true, correct and complete.
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Signature imam
ress (number and street, city, state, ZIP code)
A A"Al &A (AX I LL
R
1§51
TRUEiTAXEM
HOMESTEAD t
A �NOWRIESIDENTLAL 94
V� - ..-
�;,VALUOR4
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5 OT�
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AN -47 —W RPM
Land not exceeding I (one) acre immediately
surrounding residential improvements.
()
Other land
(2)
g >_; •'
Total land (line I plus line 2)
(3)
Dwelling
(4)
I am
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20_
Lesser of 172 Homestead
Valuation or $6.000
Signature of Auditor e-d/
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1j V
J 1,40nV461 I Dat
Snit FORM I W 111_P.-an ltEA57.1m FORM rSIA
APFBOvED BYRStE BO RDOF A(YLNrs.`an PI/SCRIBED BY THE BEtARh¢`tror LOCAL CArt4•r• FeascrIcetrr4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
• PRINCETON IN 47670 Individuals and married couples are limited to ore homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ester for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1341-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recche the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.this information will he kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Ravellette, Raymond M/Mollie A
171
Raymond M Ravellette
503 S Hudson Dr State Parcel Number Legal Description
PATOKA IN 47666-9081
�t�tt��ttt�t��rrl�� ��tr�t�tt��t tt�tt�tt tt���� ��t��r rr� 26-04-26-400-000.584-020 018-00584-00 PT SE 261116.277 AC
rrr
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
• R „Nan0( RavriGe rev-e,/474/Le
Mailing Add (number and street,city,state,and ZIP code) Same as property address
S03 Sc,/GI Y 6%t m1 ririve /foci 1 2ti J/7 6 1 o
Spouse
,r��i/ First Middle ,��/l 11 Last
��lo��e an 14 O�avej�f le
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Si e 0 yore
PART 3:CERTIFICATION ' ' - r
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is we 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 attire Date
PART 4:ADDITIONAL INFORMATION