Homestead_FlaterCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R21 5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
C! TIF19ATION STATEMENT
_
vl
I (We) Q J�Uce4t?WA44'Aarch, 19_
(We) occupied as our principal place of residence the following described real property for which a Homeste��r rtrty 7�X�redit is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract yy II y
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that ns the p�roope/�ty, ot�i buyin n�T�/ a contract.
CONTRACT RECORDED UiBSON Ci'UNTY AULJI '
It buying on wntram. Fee Simple owners name
Recorder's off" where contact is recorded
Record number
Page
PROPERTY DESCRIP-FfON
Cou
Township
Taxing trio x. wn, to sh' /
`
Ez
Parcel number _
Legal description
�
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 potion of
the property utilized to produce income.
96-,V
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
county
Township
Signature of clai
�.ereby certify the above statements are true, correct and complete.
17 2
Address (number and street, city, state, ZIP wde)
OX / 760A 4t —16XA' n/ 7666
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(2)
Total land (line 1 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
® STANDARD DEDUCTION
ALLOWANCE
- 19 Pay 19
Lesser of 1/2 Homestead
S
Valuation or $2,000
Signature of Auditor
Date signed
SIwT101%I 3 a 1I:_'I YNI 17L4SULEA POEM:SIA
APPROVED BY SHTE 141VtDCF nevMSTS.9n PILEMBED By ntr DEPAATMETT OF LOCAL GOVERNMENT ne:1TE ICI-l.1-_4i
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 ever for homestead fraud Homestead fraud causes higher tat bills for all:therefore.
• HEA 1344--2009 requires taspayers who receive the homestead standard deduction to verify that they are eligible to recent the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
fdinen.This information will be kepi confidential and can only be actecsed 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 �� e
Flater, Robert A/Traci L
R I Box 178 A 400 N 1
Patoka IN 47666
245
Robert A/Traci L Flater
R1 Box 178 A 400 N State Parcel Number Legal Description
Patoka IN 47666-9213
26-05-38-003-/0 2.298-018 C1-1 22 -00 PT SUR 3/4 1 10 9.086 AC
I 1 I I I ill It II l I I t I I I t I I t I rrr I I I I t It II l I i i I I X
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
/ogE2i a F2. 4 e. 4
ling Address(number and sweet,city,state,and ZIP code) ® Same as property address
lt0 yz F yio N 64- 7-0 K,4 1A./ "/ 76196
,
Spouse First Middle • Last
%2/tC I L FLA 762
Mailing Address(Number and street,city,state,and ZIP code) ® Same as property address
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 elieible 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 ' e el
PART 4:ADDITIONAL INFORMATION
•