Homestead_RobbCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614 -03)
Prescribed by the Department of Local GDVemment Finance 1
INSTRUCT)ONS: See reverse side !or filing instructions. FIL
I (We) y rJn �,� raYjgeo n �n�//" certify that on the 1 st day of March, 20
II r occupied as our principal place of residence the following described real property for which a Homestead Prop Arty, jax.prediOss-hereby claimed:
_j14{4e) owned El
Are buying under contract tggON
pro COUNTY AUDITOR
---' Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the perty or is buying under a contract.
rtCONTRACT'.RE_ CORDED. _e:�'�"ys_c�..'.- .iPS.d�:i•`?�i
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
�_ _,- �.z P,ROPERT,Y DESCRIPT(
County
Township
Tarin dirt cl city, nship)
Parcel number /
' OO 7
Legal description
Is the property in question:
O Real property ❑Mobile Homo ( /.C. 6 -1.1 -n
if any potion 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.
' �•.':: sz�T����w�, � .- ti.�".�St:PROP.ERTY,OWNED�.BY Ct:41MANT.IN:OTHER'COUNTIESv I£ „°�q -t't�,`3,.,#'?•,�,:?',5
,s�...,. X37 "{��--
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Si ature laimant
1
Address (nt�;er and str state, Z1P code)
® Ib/G %
ASSESSOR USE ONLY`TRUETAX
"sre
ASSESSED VALUE
"AT�100 °A
+HOMESTEAD`n
. ��
)MRESIDENTIAL
VAIUE ter -,yT
OF'T7V
,°�VALUEVALUE
Signature of Auditor
Land not exceeding 1 (one) acre immediately
(1)
jR;`°�€''-.v'•.
surrounding residential improvements.
_ 9
Other land
(2 )
Trial land (fine 1 plus line 2)
(3)
'Residential
Dwelling
(4)
n
improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
��sr� ��
cac°�s
Other improvements
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD! DEDUCTI0NALCOWANCEti
20_Pay 20_
Lesser of 112 Homestead
S
Valuation or 535.000
Signature of Auditor
Date signed
•
s1NE Fn0.M53v+,Ru fw) TRFAniUR FORM SIA
srnrr ED BY MAIL BOARD INnerrAINIA.1n. PRIrRIBED BY TUE DEPARIMEYTOF LOCAL rwvsrn!nna FINANCE h'VL.lt-!.,
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead uandani deduction.As the receipt of this deduction becomes
more beneficial.there is more incentbr than ever for homestead fraud Homestead fraud causes higher in bills for all:therefore.
• HEA 134.1-2009 requires uspapers who receive the homestead standard deduction to verify that they are eligible to teethe the
benefit and to provide additional identifying information necessary to allow county^_ovemment to better monitor homestead
filings.This information will be kept confidential and on only be accessed by authorized county officials.The Depannsent 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 Propem'Address
Robb, Bertis Allen
120 S Main
Patoka IN 47666
606
Bertis Allen Robb
120 S Main St State Parcel Number Legal Description
PATOKA IN 47666
26-04-25-102-000.462-020 016-00462-00 PT NE NW 25-1-11 .33 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
rg Address(number and street,cir) state.aid ZlP code) "— - ——'. -- _ -12 Smile as property address-- — — -_ - — _ - - -
J 0 s. 111 a n -Cf. P fi0 Ken �� Li ��6
Spouse First Middle Last
Mailing Address(Number and street.city,state.and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please spttify in Part 4 below)
saw
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.
Spouse Signature Date Telephone
\ )
PART 4: ADDITIONAL INFORMATION
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