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Homestead_HulfachorR� CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT /STANDARD DEDUCTION State Form 5473 (R6/4-03) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse side for filing instructions. I (We) occupied as our principal place of residence the Bowing described real property for which a F I (We) owned ❑ Are buying under contract / 1 ' Have a beneficial interest in the entity that is liable for the property taxes on the property and that FORM YEAR HC10 certify that on the 1 day of March, 20_ stead Property- T"Eviit is hereby claimed: is buvina under a contract. If buying on contract. Fee Simple owner's name - Recorder's office where contract is recorded Record number Page �i '- ' PROPERTY ON%NEb:BY;CLAIMANT IN OTHER-.000NTIES . County Township ERTYDESCRIP,TIDN County Si a e of claimant Township Testing district (city, town, township) Per 1 1 nO lb r® ©KI al d nption _ _ I w . O 3 Is the property in question: ❑ Real property ❑ Mobile Homo (I.C. 61.1 -7) 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. r'z -Q3 -a - j oo -oao. 7�9 -o0, �i '- ' PROPERTY ON%NEb:BY;CLAIMANT IN OTHER-.000NTIES . County Township County Township hereby certify the above statements are true, correct and complete. Si a e of claimant itres n berand t, city, state, ZIP e) — <- ASSESSOR USE ONLY i �' s ' -. ; <.'- I�RUE TAX t- S8ESSED VALUE L� ,HOMESTEAD S+Ltig.Fans- NON ESIOENTIAL y=t::_, r." • VAL_UE'�'` .. AT: t00Ye OFrTNNVALUEy'VALUE. y, Land not exceeding 1 (one) acre immediately. surrounding residential improvements Other land (2 ) Total land (line 1 plus line 2) (3) Dwelling (4) . - - Residential Improvements or Annually Assessed Mobile / Manufactured Home Garage 9�• Other improvements P (6) s 471K. x`2i�v�.-r�i, z Total improvements (line 4 through line 5) (7) Total value (line 3 plus line 7) (6) I hereby certify the above is true, correct, and Signature of Assessor Date signed complete. Verifying action - Signature of Auditor Date signed a,�STANDARD!DEDUCTIONALLOWANCE 20 _ Pay 20 Lesser of 112 Homestead valuanon or 535.000 Signature of Auditor Da 'gne ' SIMIE FORM SAT.Irn 1111ASUIIR PORN.Z.tA APPROVED BY STATE BMRM Of ACCOUNTS.BED PIF.47113m BY Tar BEPARTecirr OF LOCAL CASTRNNrNT Fact IC4t.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 ever for homestead fraud homestead fraud causes higher tas bills for all:therefore. REA 1344-3009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the benefit and to provide additional identifying information necessary to allow county government to better monitor homestead tiling.This information will he kept conliderltinl and can only be accessed by authorized county officials.The Department of Local Gotentment Finance will use this information to create tads that will help county officials eliminate homestead fraud. PART I: PROPERTY INFORMATION Taxpayer Name Property Address Hulfachor, Darvin E CR 350 N Patoka IN 47666 211 Darvin E Hulfachor 7472 W 350 N State Parcel Number - LeeafD`scription — PatokalN.47666-9267- _ - - Itlttlll rtl tiler t��rrr��rr�r�r rrr�l�t��r r�ttt��t tt�tt�t��tt�t� 26-03-24-300-000.439-018 010-00439-00 PT SW 24-1-122.03 AC PART 2:TAXPAYER INFORMATION Owner I First Middle Last DAR veAT El pt)L [Pc F f) nri? -—�g Address(number and street,city.state,and ZIP code) - - - -- — - U-Same as property a ddro, -- —— --- - --- 7 72 CI). -3 Sion) -?e fk/f- • Spouse First Middle Last Mailing Address(Number and street,city,slate,and ZIP code) Same as property address Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please spaifv in Pan 4 below) sate PART 3:CERTIFICATION - - Each undersigned certifies,under penalty of perjury,that the above and foregoing information is toe 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 r