Homestead_ColvinO ny
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/5-92)
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INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
I (We) _ _ C� _ certify that orVe 11 dly fA
INIV-
I (We) occupied as our principal place of residence a follo in scribed real property for which a Homestead Property je�rFi 2 is hgMoclaimed:
�I(We)owned ❑ Are buying under con ract i[D [ 't LUUU
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pro y or is buvirlu u
J. r a co IX.
rncn. t1hTY:,UDo
CONTRACT RECORDED
If 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
County Township County Township
I hereby certify the above statements are true, correct and complete. ig tune aimant �/
ss (number and street. city, state, ZIP code)
/ Z��' U.✓ .2�v Y7� �v
'PROPERTY DESCRIPTION
County
Township
NON - RESIDENTIAL .
Taxing district (pry, town, township)
Parcel number
o- -
Legal desc
a -1 -�Q 133 3r-��
It any 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.
-
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true, correct and complete. ig tune aimant �/
ss (number and street. city, state, ZIP code)
/ Z��' U.✓ .2�v Y7� �v
STANDARD DEDUCTION ALLOWANCE`- ' -
TRUE TAX
ASSESSED
HOMESTEAD;
NON - RESIDENTIAL .
- .ASSESSOR USE ONLY
-
VALUE
VALUE
VALUE
VALUE
Land not exceeding t (one) acre immediately
Date i netloQ — ®-D
surrounding residential improvements.
_
Other land
(2)
-
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
-
Other improvements
(6)
Total improvements (line 4 through line 6)
(7) "
Total value (line 3 pf6s line 7)
(6)
hereby Certify the above is true. correct, and
Signature of Assessor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE`- ' -
19_Pay19_
Lesser of 112 Homestead
$
Valuation or $2,000
Signature of Auditor
Date i netloQ — ®-D
STSTE FORS'nx.,R_/srv1 TRFASLm FORM 5-IA
.APFRtWED BY Sr STE BMRDOE AfnnXL•TS.9v PrrSTIBm BY TT DEPARMEn ft LOCAL GOVERNMENT maser 1e 1.I.I-: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 standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e'er for homestead fraud.Homestead fraud causes higher tax 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 ir provide additional identifvin2 information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and c-an only he accessed by authorized county officials.The Department of
Local Government Finance will use this information to create LOUIS that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Colvin, Donald C/Sharon I
5689 N Tripper Rd
PATOKA IN 47666
278
Donald C Colvin
5689 N Tripper Rd
PATOKA IN 47666-9108 State Parcel Number Legal Description
till t�tt�t�tt�t�t�t tt��tt� 26-05-58-0433-(002.300-018 010-02300-00 PT MD 42/43 1 10 13.33 AC
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This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
Owner I First �* Middle Last
DoNAL-D l UgTiS CoLv/N
•ng Address(number and street,city,state,and ZIP code) ® Same as property address
5(08q N TRIPPEV RD PATor.A, /N 47(06(0
Spouse Firm Middle Last
5/-I AR oN rgETIC= Coy vin/
Mailing Address(Number and street,city,state,and ZIP code) I:.'Same as property address
5(0 8 q N TRf PPET tR D AW KA( /Al 47(06c,
IJ
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
PART 4:ADDITIONAL INFORMATION