Homestead_ShawCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
uu State Form 5473 (RS I IMI )
Prescribed by the Department of Local Government F'mance
INSTRUCTIONS: See reverse side for Filing instructions.
I Me)
I (We) occu as our prirUpal place of residence the following described real property for which a
FORM YEAR
HC10
LEA
certify that on the 1st day of March, 20_
7
,stead Pro�ertySax Credit'Is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
GIBSON COUKTY AUDI TOP.
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.
s 0a I°W2 M'�44'i`i= - � ysa �% NTRACT(RECORDEO1t" -.air.
If buying on contract, Fee Simple owners name
Recorders officer where contract is recorded Record number Page
+ 2�" �- �- u'" f- �` 2+ �?l��ik�' i` s���.iy';?�gFROP.ERTYnOWNEDjBY; CLAIMANT,' IN; OTHEIrCOl1NT1ES'�?�S���v„� -�:�? °- �`F?�_
County Township
'�.... ERTI: - dESCRIP,TION ,' r - `.a3 -,�'`s i'eu-. -'. =
County
Township
dress (u C dry, to ZIP code
Taring district (city, town, township)
P I r�/y�ber \
V '0 -0 U
Legal de 'p6
l
VALUE
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Is the property in question:
❑ Real property ❑ Mobile Horne(I.C. 6- 1.1 -7).
H any portion of the residential structure or the land n ex
of the property utilized to produce income.
ing one (1) acre that innibediaiely surrounds that structure is used to produce income, describe the use and portion
+ 2�" �- �- u'" f- �` 2+ �?l��ik�' i` s���.iy';?�gFROP.ERTYnOWNEDjBY; CLAIMANT,' IN; OTHEIrCOl1NT1ES'�?�S���v„� -�:�? °- �`F?�_
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signatur of claimant
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dress (u C dry, to ZIP code
yALUE`
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AT't0060FTTV
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=�ASSESSOR�USE ONLY'a a
TRUETN(
ASSE5SED VAGUE
eHOMESTEAD.
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'� NON` - RESIDENTIAL
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s VALUE
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VALUE
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Land not exceeding 1 (one) acre immediately��
surrounding residential Improvements.
Other land
(y)
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k._ _.:''
Total land (line 1 plus line 2)
(3)
Dwelling
g
O
Residential improvements
Gars e
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
hereby certify the above is title, correct, and
Signature of Assessor
Data signed
complete.
Verifying action - Signature of Auditor
Date signed
20_Pay 20_
Lesser of 1/2 Homestead
Valuation or $6,000
Signature or Nrddor Date signed " L4 03
STATE FORM 53569(R28A9) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,20D9 - PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 106-1.1-12-13 1
13�P 0_ ' £It`W:Q71HOO ! a_ T A D °L'r,° 0 ' .(0�'n�2t:
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
•auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive the homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
information necessary to allow county government to better monitor homestead filings. This information
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
"; •° - PROPERTY I■FORM
Tasoave-Name Property Address State Parcel Number Leal Description:
Gary W/Tina L Shaw 106 Spring 2644-24-304-000.327-020 018-00327-00 COL DIV 75f9
Patoka IN 47666
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
c _t :r z 1"''4 a cam 3.
:FS-• S?"�i�- u ��:
Owner I First Middle Last
GfiRy L„imey,ve Si/fie-4J
Madmg Address(number and street.ay,state and ZIP code) I�'�Same as property address
f A floX 64 IOC s PR ,,/C- St t,t r,- *7G 6 6
•
Spouse First _ Middle Last
s H c,J
•
Mating Address(number and street,city.state and ZIP code) Same as property address
k :„twt r,$ 4.4i =T'E Pa�RT3 CFKTIFfGAT10Vusingsm.743
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 1 Signature Date
j, `, . ART.almsNFORMATIION
