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CLAIM FOR HOMESTEAD PROPERTY TAX
YEAR
CREDIT/STANDARD DEDUCTION
State roan 5473 (R71 SM
Presaiload by the DeperUrmd of Local Cqovemnmt Fnaince
INSTRUCTIONS: See reverse side for Ong instructions. YVE
-CERTEFICAMM STATE]k[W,. r '- T'.' - � , , ; '. -
I (We) m car* that on the I st day of March, 20_
I (We) k"ng described real property for which a Hornestesid Property T. W&�Weat claimed
W (Vft) owned El Are buying under contract GIBSON COUNTY AUDITOR
Haive 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
�,.CONTIRACT41RIIECOIRDIEID,�t,'
pmaNdees, offxe what/ contreol is recorded Record nurnlow Page
PRW
PROPEM 0ESCMFrn0W.',,'
Township
C-"
Township
I hereby carbly, the above statements are true. correct and complete.
T 'W disdrict (
barn, townsftp)
Parcel mvrbar
- 6 `- a5 - I b�) -
Lao description
(�) /--� -, 7 � 5 L -
b the popely
. 0 question:
Meet wow y ❑ Motile Horne (W. 6-1.1-7)
portion of the resklardid struch" or the land not exceeding one (1) ecre that wranedialmily surrounds Cud shicture m used to produce inm ne. desoibe the use and pm tkm
prop" uUmd to pT&m avoorne.
PRW
County
Township
County
Tawrmhip
I hereby carbly, the above statements are true. correct and complete.
Signature Of I
C,
1b,ress (amber and
-7V;
? NWi Z
,ASSIESSM USE bkbi
VALUE
NON4MSMEN
Land not exceeding I (one) am immediately,
gg
ni
surrounding residential improvements.
R
Other land
(2)
Tctd land (1km I pka &m 2)
(3)
Dwelling
(4)
Residentialm4xvvernents or Anrujaily
Assessed Mobile Manulactised Horne
Garage
( 5)
® AAi*�
WS
r R
Other upmements
TdW anprovements (&* 4 through Ine M
TcW value (Ikm 3 p&G lino 7)
(8)
1 hereby certify the above is true. correct. and
SWOMM of Assessor
Date signed
complete.
VwtWq action - Svmome of Auditor
Date signed
20 _ Pay 20_
Lesser of 12 Homestead
Valuation or 536,000 I
•
•
' x1551 FORM!3!tAIR]/s1 TAEAti11RER FORM IS IA
ArrRts'EO BY STATE BOARD 0I-AM11RPTn.20. PRraatnmm BY 111E DIM n 54T(FL(s:AL GOVERNMENT FI:ANCEWfr1.I-1:4.l
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N Main
PRINCETON IN 47670 Individuals and married couples are limited to ore homestead snndard deduction.As the receipt of this deduction becomes
f to more beneficial.there is more incentive than ner for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
HEA 134-1-2009 requires taspayers who receive the homestead standard deduction to verify that they am eligible to receive the
benefit and to provide additional identifyin_ information necessary to allow county gmemment to better monitor homestead
liling.this information will be kept confidential and can only be accessed by authorized county officials.The De amnent of
Local Government Finance will the this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ White, Tracy
116 S Main U
/� • Patoka IN 47666 Q
595 \i
Tracy White
�'
P O Box .J� State Parcel Number Legal Description
IN
PATOKA IN 47666-0102 v
Iilitllirrlillrrtllrrrllrrll 1111 1 iii 111111 26-04-25-102-J,0(0/0.156-020 018-00156-00 PT NE NW 25-1-11 .43 AC
. - - - - -- - PART 2:TAXPAYER INFORMATION
Owner I First I Middle I ' \M Last
i--- i n i y/`-�, 1 ( 4-C-
�g Address thumper d sGeet,city,state,and L}p code)-- - - -- 0 Same as property-udder n - —
1 ((r S . Anil `l-1-.[. 6- hf-=. r1-.) —� I, 4-Vol,.1, Po h.l J/l )n-2
Spouse First Middle Last
Mailing Address(Number and street,city,state,and LIP code) ❑ Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please sluify in Part 4 below)
_____________ . S=--
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.
Owne I Signature �
Spouse Signam�c Date Telephone
PART 4: ADDITIONAL INFORMATION
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