Homestead_DouglasCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (8215-92)
INSTRUCTIONS: See reverse side for filing instructions.
s
FORM
HC10
YEAR
® CE ICATION STAT ENT
I (We) cert t t o i l t d of rch, 19_
I (We) occupied as our principal place of resid ce the following described real pr p for which omestead Property Tax redi Is ereby claimed:
❑ I (We) owned ❑ Are buying under contract MAR 0 Z 2001
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that own5.1he property or is uying under a contract.
CONTRACT RECORDED T
If buying on contract, Fee Simple owners name -
Recorders office where contract is recorded -
`
Record number
Page
PROPERTY DESCRIPTION
Township
Taxing di (cl ,
arce number
0 0 -0 a3i�► -3
Legal description
(o. 3g8 RC
If 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.
7_ ODD. 3 17 —D/P
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
ereby certify the above statements are true, correct and complete.
ignature of claimant
d
_ A ess (number and street, city, state, ZIP code)
3 c X -7 7 Pl1 to K µ
ASSESSOR USE ONLY
TRUE TAX
VALUE
- ASSESSED
VALUE
HOMESTEAD
VALUE
- NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
(1)
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 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
Verifying action - Signature of Auditor Date signed
_V
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 112 Homestead
$
Valuation or $2,000
Signa re I Auditor
Date signp4
O/)t
SIAIE FORM•3Waerw+1 TREASURER FORM T11A
AFFRP'FD BY Sf.TEW RD(W nrtTRtS'FS.ww PREYATBET BY TIE DEPART/CDCOr LOCAL rorrVMrrn ra:ANCE B'BI.I-2:4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples arc 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.Iomestead fraud causes higher tax bills for all:therefore.
• HEA 1544-2000 requires taxpayer,who receive the homestead standard deduction to.erifv that they are eligible to recene the
benefit and to provide additional identifying informanun necessary to allow county gocernnlent to better monitor homestead
tiling+.'Ibis information will he Lept confidential and can only he accessed by authorized county Officials.The Department 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
Douglas, David H/Dorothy M
RI Box 77
Patoka IN 47666 V
984 frDavid H/Dorothy M Douglas
R1 Box 77
Patoka IN 47666-9102 State Parcel Number Legal Description
I tI o I I oIII n I I uI I 11 I I uu'III I I I I I I I I I 26-05-58-007-002.317-018 010-02317-00 PT MD 7 1 10 6.398 AC
tF Fr F F unrt n tot m u
PART 2:TAXPAYER INFORMATION
Owner I First ' / Middle Last
A V i d l7 o XS LA s
8 Address(ntlmbcr aanndl"street,city,state,and ZiP code).—/'— -_ — >—O Samc as prcpem;adL�s-_ __ _ _ _. . _ __
a-1 L,(� l�ee in)cinl Rol +° /�A, //I/ 47& -&
Spo First Middle Last
A-f-h y /1 .):De) /-9s
Mailing Address(Number and street,city.state.and ZIP code) Same as property address
g L0 8-t-ee 1 rMA) Rd �/} • A- 277h,
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 ''nn' Date
0, aly
° °' PART 4:ADDITIONAL INFORMATION