Homestead_Breen0 CLAIM FOR HOMESTEAD PROPERTY TAX
• CREDIT /STANDARD DEDUCTION
State Form 5473 (R817 -07)
.«. 1 Prescribed by the Department of Local Government Finance
INSTRUCTIONS., See reverse side for filing instructions.
I (We) — t`MXAJ Ila T rCAOW
I (We) occupied as our principal place of residence the
FORM YF�R
HC10
p6ffJL& 1 I '_ certff9 tharon f st day of March, 20_
described real property for which a Homestead Proger(y,Ta�( CFedreby claimed:
I (We) owned ❑ Are buying undercentracl i;Ul7 1 LUVU
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
If buying on contract, Fee Simple owner's name
office where contract is recorded
Counly
Taring district (city, town, township)
Racord number
a contract.
Page
Parcel numb Legall tl�escdp' Is the property in question:
-�� -�d •SOD ? y0 lot MK. M�l�l I ! A ❑ Real property ❑ Mobile Home (IC 6- 1.1 -7)
If portion of the residential 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.
20 _ pay 20
Lesserof 12
Homestead Valuation
or
45,000 for 2007 pay 2008
44,000 for 2008 pay 2009
43,000 for 2009 pay 2010
42,000 for 2010 pay 2011
41,000 for 2011 pay 2012 $
40,000 payable after 2012
Signature of Auditor Date sped
g Win I•. n_ SYI
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2);
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually
Felling
(4)
•.. :. ,; : xw
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
.
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus Line 7)
(8)
1 hereby certify the above is true, correct, and
Sgnature of Assessor
Date signed (month. day, year)
complete.
Verifying action - Signature of Auditor
Date signed (mm1h, day, year)
20 _ pay 20
Lesserof 12
Homestead Valuation
or
45,000 for 2007 pay 2008
44,000 for 2008 pay 2009
43,000 for 2009 pay 2010
42,000 for 2010 pay 2011
41,000 for 2011 pay 2012 $
40,000 payable after 2012
Signature of Auditor Date sped
g Win I•. n_ SYI
•
SLATE FOAM!LW.iR_/w.v1 TRF-W:tEll fORM T}IA
.APIIOWEO MY STATE w1 Dof ACCOOTS.!nv PRISCRIZED BY THE DEPAITEVTOE UXAL GOVERNMENT FINANCE Ie<Lt-r-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 s andard deduction.As the receipt of this deduction becomes
— more beneficial,there is more incentive than ner for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
® HEA 344--2009 requires taxpayers who receive the homestead standard deduction to verily that they arc eligible to rrcene the
benefit and to provide additional identifying informamon necessary to allow county government to better monitor homestead
tilint5s.This information will be kept confidential and can only he accessed by authorized county officials.The Department of
Local Government Finance will use this information to create with that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Breen, Robert S II/Pamela J
-- Old 11S 41
PATOKA IN 47666
9
Robert S II/Pamela J Breen
6126 N Old US Hwy 41 State Parcel Number Legal Description
HAZLETON IN 47640-9220
26-01-12-200-002.406-018 Pt NE 12-1-11 1 Ac
Itlnllntltllu nntl iIiI�n�ultl
PART 2:TAXPAYER INFORMATION
••n• I First Middle Last it"fso- - \e
`- g Address(number ndstrea,city,sate,-and ZiP code)— —_— __ _ _ .►� 5amc as prepem address__ _ _ __
\a\c)t \ O\a_ Lb5 \-\k ;u N � ,��t��.���\ K- eel (14cm
P715; First Middle Last
tl \ci Pe
Mailing Address(Number and street city,state,and ZIP code) Same as property address
K_o 41 Oc b 4J u L\l N -7E_NC.
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 1 Signature Date
PART 4:ADDITIONAL INFORMATION
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