Homestead_Anthis7 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
/ State Form 5.473 (132 / 5 -92)
INSTRUCTIONS: See reverse side for riling instructions.
CERTIFICATION
V�
FORM YEAR
HC70 �/
-
D .--
Nr EN
certify that on tfi I•�.ssyt��aaj�grch, 1
�•cI pie 0s our principal place of residence the following described real property for which a Homest 4g Abt •t -4R hereby Galmed
/ Nv
❑ I (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 buying under a contract.
CONTRACT RECORDED
It buying on contract, Fee Simple owner's name - - - -
Recorder's office where contract is recorded Record number Page
-
PROPERTY DESCRIPTION
County
Township
Township
Taxing district (city town. township) -
Parcel number
-O
i tion
al description
g`
It any portion of the rest en6al 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.
(2)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
certify the above statements are true, correct and complete.
1W
Signature of claimant
Address (number and street, city, state. ZIP code)
PO. t50z_ s 3 P,9 o
if
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 Auditor _
Other land
(2)
Total land (line f 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)
f hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
, 9 action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE -
19_Pay 19_
li
Lesser of 1/2 Homestead
5
Valuation or $2,000
Signature of Auditor _
Dare s1 ned
FM
MATE FORM•!W ICI!W I ThEASUWI FORM.73-IA
APPROVED BY STSTE BOARD of MY.TtLS'R.!vv PLESClUBm BY 111F.BEPARTLYFOF LOCAL nM£RYMFAT raascEM.-1.1rj.I
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 bermes
more beneficial,there is more incentive than ever for homestead fraud.homestead fraud apses higher tax hills for all:therefore.
•1 HEA 1347-2009 requires Taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identnying information necesmni 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 mots that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Anthis, Jim B/Lora R
350 N
Patoka IN 47666
599
Jim B/Lora R Anthis
• 4309 N 4tt Rd State Parcel Number Legal Description
Patoka IN IN 47666-9171
III I I I I I I III uI I I I I I I I I I 26-05-38-003-002.069-018 010-02069-00 PT SUR 3 8 41 1016.65 AC
ou
ru tot ru ur a tt tnr ctrl nt ie / C-1-D-12
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
—71 ,VI �or� HA)i H IS
1g Address(number and ifeet.city,state,and GIP code)
H305 N y[ 1 PPt%7T I:IJ• PATC*9 1-1' 6 6
Spouse First Middle Last
LOfa „ Che,l � An Lk 5
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
14 30 \ N . "Tc- Q ? ' QaoV,<.. mkt LA-16 L
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