Homestead_BrownCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT /STANDARD DEDUCTION HC10
State Fwm 5473 (Ra / 4-03)
Prescribed by the Department of Local Government Finance 111 0
INSTRUCTIONS: See reverse side for filing instructions.
ERT1F T_ION,S_T_AIEMEN_T,s` ��a�,.,r5;'s_'t����'s• =�'' ��??s:.;`a��`&n°_- '= ,c�':%
(We) QC rtity the on the 1 /st da pf March, 20_
(We) occupied as ou p cipal place of residence the following described real property for whi a Homestea Pro Tax Grr c' is hereby claimed:
❑ I (We) owned ❑ Are buying under contract OUr T y Uh DI TOR ,
`Have a beneficial interest in the entity that is liable for the property taxes on the property an aSlii�n�srthE property or is buying under a contract.
wCONTRACT!RECORDED"
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
- .�1..''..»"cPROP.ERTY;OWNEUBY' CLAIMANT, IROTHER `COUIJTIES,..raei`�'€31`^ t
�4',. v', vsP, ROPERTY< CESCRIP.TION„"%*..'.'t,.'t',rg3 ="fir - ..c`ay.,z`vSP'Yf,1f.S-
Cou
Township
Taring district (city, town, t
Par
/CO
Legal
Mpeny in question:
m
-OO w
TAX
(1)
Real property ❑ Mobile Homo (LC. 6-1.1-7)
If any portion of the residential sW chrre w the Wnd nd exceeding one (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utiiaed to produce income.
aG - 6
- -
- .�1..''..»"cPROP.ERTY;OWNEUBY' CLAIMANT, IROTHER `COUIJTIES,..raei`�'€31`^ t
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, city, state, ZIP code)
Sign ur Au w
- ASSESSORiUSY' x�"TRUE
su „„s;se,,;.r;.� jVAI:UE,
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
TAX
(1)
ASSESSED VALUEJHOMESTEAD4
!AV 00 %:OFTTV,
�'- ',VALUE'
ANON- RESIDENTIAL
E('t'VALUE�,W
eH =
�,Yi'Z�y�._ U
Other land
(2)
4s
'tr+s�
Mu
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually
Assessed Modb I Manufactured Home
Dwelling
Garage
(4)
(5)
V 44ki
,r`- ,
"' '` '�"- '^`�" a
fRI 7rs
�'r' =�?`
Other improvements
(6)
5. r—W-171-54WIri
Trial improvements (line 4 through line 6)
(T)
Trial value (line 3 plus line 1)
(S)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
<
ss 't V ` ` STANDARH;DEDUCTIONALLOWANCEeT5 �.''Z --V`„
20 _ Pay 20
Lesser of 1/2 Homestead
S
V9uation or
Sign ur Au w
Date sppgd_/
/UU
•
llA11 I ORM,,t.sp /vPo tt{rASUL(RW0.4gIA
.,,rRtv,'ED 11Y CI kit anUnrw ACCOUNTS.IBM •rl[A1BEW or nu-nEMarsert Of toast novatiMF.AT ENANCE IC 6-1.1,15-A I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and hurried couples arc limited to one homestead standard deduction.As the receipt of this deduction become,
- more beneficial.there is more incentive than tug-for homestead fraud.homestead fraud causes higher tat bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reecho the
• benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.'Ibis information will be kept contideruial and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create teens that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION •
Taxpayer Name Property Address
Brown, Robed Date
RI
Patoka IN 47666
368 - -- - ---- '-- - - ° _ - .
Robert Dale Brown
1001 W 550 N State Parcel Number Legal Description
Patoka IN 47666-9057
I I I I I I111111I I I I I I I l t u I I I I I l 111I 1111111111 l l t I I I 11111111 26-04-12-300-000.106-018 010-00106-00 PT W SW 12-1-11 55 AC
PART 2: TAXPAYER INFORMATION
Owner First Middle Last
oBgg U A- E BRo wd
. ._ •ng Address(number and street,city,state,and ZiP code) — —
/00 I W 6S0 & P pyre 4 I N 1/71 Po
Spouse First Middle Last
SHIRAE / R A/ o 8Rown/
Mailim;Address(Number and street,city,state,and ZIP code) Same as property address
100 I w sso -roKA i n/ /17666
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
PART 4:ADDITIONAL INFORMATION
•