Homestead_Williams (3)a CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
YEAR
certify that on th� Ld�j o,t1t1 M��ttaprrc��lh1, 19�
our principal place of residence the following described real property for which a Homestead Property eedfi liwilaimed:
�l (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 *%y y �I1�5,(eRct.
CONTRACT RECORDED
It buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County -
County
Township
Taxing istdcl try, 1 wn, wnship)
Address (number and street, city, state, ZIP code)
-PO 3s
rc of mber00
Legal description
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that stru .ur is used to produce incom ,
of the property utilized to produce income.
describe the use and portion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County -
Township
Seby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, city, state, ZIP code)
-PO 3s
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Audi;
Other land
(2)
Total land (line I 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 plrs line 7)
(6)
1 hereby certify the above is true. correct, and
complete.
Signature of Assessor
Date signed
a W—ifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
S
Valuation or $2,000
Signature of Audi;
Date d
- aq -9 3
3i.rit FORM 3rt+1R`/wn ThZAS1:RERFOEM:StA
APPROVED BY SlVE BMRDOF MltNIA.4n PEEYInBWBY ntr DEPARMENT OF LOC.&rnstRNSIrrR FINANCE icist.trai
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 user for homestead fraud.Homestead fraud causes higher tar bills for all:therefore.
• HEA 1344-21)09 requires taxpayers who receive the homestead standard deduction to verify that they are eligible m receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kepi mntidaminl and can only be accessed by authorized county officials.The Depanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
•
Williams, Tony
PO Box 351
Patoka IN 47666
570
Tony Williams
P O Box 351 State Parcel Number Legal Description
Patoka IN 47666-0351
II ' II .• II .• II rr't I Itrl•.r I l I Prrt II t•,i,I 26-04-25-101-000.177-020 018-00177-OO BARNES ENLG 85PT/86PT
r rr 1rr t rlr 111 1r
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
/ti IAJA,kj AJe Zv t/44»,J
Itdttt, 1Pcode) -- - - - -'- ---Same m property address
— - - IC -- -
v,L
oI07e 3. 6- 1 PATonM tw .97644 ._7o6 Go m/ii JT & A- �r
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Li Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sus
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
Spouse Si rare Date Telephone
( /
PART 4: ADDITIONAL INFORMATION