Homestead_Williams1)
E° CLAIM FOR HOMESTEAD PROPERTY TAX
a/
d_6 ,11 CREDIT /STANDARD DEDUCTION .
State Form 5473 (R2/5 -92)
INSTRUCTIONS: See reverse side for tiling instructions.
n
FORM YEAR
HC10
' -
County ...
CERTIFlCA ION STAT NT - -
**p,ed on the 1 st day of March, 19
as our principal place of residence the toll ing describe eal property for whit a omestead Property Tax Credit is hereby daimed:
,_(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 cta
. tc ship)
IV
Legal description
If any portion of the residential Mructure 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. -
4- '](�Gl
- CONTRACT RECORDED --
If buying on contract, Fee Simple owner's name - JUN 2 (16
V I` O O 19J
Recorder's office where contract is recorded
R rd number) P.e7V
AUDI I VR
PROPERTY DES IPTION
County ...
Township
Taxi dist L,(ci• to
. tc ship)
r mbe,
I
Legal description
If any portion of the residential Mructure 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. -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township
County Township
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
eby certify the above statements are true, correct and complete.
- at ire of "i t
Address (number yn61 cyy.Rate, IP code)„
11,2 11 11A.//ll -- /�a*a Tom/
4- '](�Gl
• - - - — - - - I - -
ASSESSOR USE ONLY
TRUE TAX
-VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
lualion or $2,000
Signature of Auditor
Other land
(2)
Total land (line 1 plus line 2)
3
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
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
complete.
Signature of Assessor
Date signed
"�^•ifying action nature of Auditor
I
I Date signed
STANDARD DEDUCTION ALLOWANCE
19 Pay 19_
;
Lesser of 1/2 Homestead
6
lualion or $2,000
Signature of Auditor
IIAit FORM: !M1 M1:/✓MI - TRFASULER FORM 3IA
APPROVED BY STATE BOARD OF MVYt'NTS.p.v errnnm BY no DEPARTMENT OF LO CAL DOVZRNMENT FacANCE IC 64.1-2:4.1
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 ever for homestead fraud.Homestead fraud causes higher tat hills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they am eligible to receive the
benefit and to provide additional identifying information necesa`I,ry to allow county government to better monitor homestead
filings.This information will he Leo confidential and on only be accessed by authorized county officials.The Department of
Local Government Finance will u¢this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Williams, Jack D/Jennifer L
112 West ST
Patoka IN 47666 •
128
Jack D/Jennifer L Williams
112 West ST State Parcel Number Legal Description
Patoka IN 47666
26-04-25-101-000.308-020 018-00308-00 PT NW 25-1-11 .6437 AC
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
OA ki CO `> ll �9.nS
isr. (number and street,city,state,and ZIP code) 121 Same as property address
j/01 ,5007 P64.14:01- I 9,I1cKtf zM 4/7666
Spouse First Middle Last
Ile
h5 nn � r Lyh il
Mailing Address(Number and street,city,state,and ZIP code) 1-Panic as property address
// 0 5 L'Je t itref_
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.
Owner I Signature Date