Homestead_CattI � 1
noState CLAIM FOR HOMESTEAD PROPERTY TAX ` FORM CREDIT /STANDARD DEDUCTION FE 2 8+199 Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side for filing instructions.`1„/. -r
fG 8SOn, c S.; •(TV ^LID!TOR
r. - =.CERTIFICATION STATEMENT:
'n1), certify that on the 1st day of March, 19
I (We) rupied as -our principal place of residele the following described real property for which a Homestead Property Tax Credit is hereby claimed
❑ I (We) owned ❑ Are buying under contract
`7 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 -,: ,.. ; -. -- ::_ . e , .. �•__ s, _
It buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
.PROPERTY DESCRIPTION -
County
Township
Township
Taxing di ri (city, town nship)
Parcel number
Legal description
y -
Other land
S� _,le - 8 c,
If any portion of the residential structure or the land not exceeding one (1) acre that immediatey surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
- 6 SL�.3 -
/
. 613 - O/
o - � /
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Morass (number and street. city state, ZIP code)
- ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD "
VALUE
- NON - RESIDENTIAL"
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
>
Other land
(2)
"
Total land (line 1 plus line Z)
(3)
Residential improvements
Dwelling
(4)
-
Garage
(6)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE-
19 _ Pay 19_
Lesser of 112 Homestead
Valuation or $2,000 $
Sgnat of Aud r Date signed
MATE FORM OAl AN WO IAFANFER FORM 1A-IA
APrnWtO BY CrAMI BOARD OF ACCOUNTS,dew PFIDCRIam BY nil DEPARTMENT OC LOCAL(ArRYMI.A'T EC:AACE IC-I.I-L'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 nundanl deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e'er for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
® HEA 1343-2109 requires aspalers who receive the homestead standard deduction to verily that they are eligible to reeene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and can only he accessed by authorized county officials.The Ilepanntenl of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address _I
Cott,Jerry D/Carolyn J 1V
175 W \
Patoka IN 47666 1 -y
436 15 A U
Jerry D/Carolyn J Call
R 1 Box 199 State Parcel Number LeEal Description
Patoka IN 47666-9243
�r�tt��ttr�t��ttt��ttr��It�t�IlI�t�r�t t�tt��tt�� 'lilted 26-04-23-300- 00.413-018 010-00413-00 PT SE 23-1-119.88 AC
C-1
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Jeif p , TV;OA) At-f-
�CAtltlresstnumbel and;rtes[.city,state mid ZiP cede) - — _.-- -- - — pAl Y Same as property addres -- ---- — - -
.97601 AJ / 75 0 Stir 4 - ti 1 ( 6G
?
Spouse First Middle - Last
Arol�d tpA13 fi 0 ATr
Mailing Address(N tuber and sweet,city,state,and ZIP code) ® Same as property address
3-7( k) its n-f-L AA- Tj. z/769GI
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is tme and correct and that he or she is eligible to -
- receive the homestead standard deduction oil 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
• i