Homestead_Hulfachor (2)CLAIM FOR HOMESTEAD PROPERTY TAX FpRR��11 YEAR
}� CREDIT /STANDARD DEDUCTION �FiIa
State Form 5473 (R2 15-92)
rbu pppp 1994
INSTRUCTIONS: See reverse side for tiling instructions. EF! pp !'��
CERTIFICATION {STATEMENT
certify that on the A1 st day of March. 19_
I (v a) occupied as#ur principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract
❑ 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
If buying on contract, Fee Simple owner's name -
Recorder's office where contract is recorded Record number Page
`
PROPERTY DESCRIPTION -
County
Township
Sin claimant
Taxing district (city, town, to •nship)
Parcel number
Legal qgFription
d G l -60
Other land
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
�ereby
Sin claimant
cenity the above statements are true, correct and complete.
1.
Atl ress (number dnd street, city, slate. ZlP erode)
71JL Li
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 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 psis line 7)
(g)
I hereby certify the above is true, correct, and
mplete.
Signature of Assessor
Date signed
.fyug action - Signature of Auditor
Date signed
STANDARD
19_Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000 S
of Auditor are
signeu
• •. ' StAIt 10RS1'lWtR:t‘-wt TREASUIER mtM TS-1A\
.ArtirKEB BY MITE BOW)M NTT*ITS9B ILEYWBIo BYl11r DEP.. ThcT OF Lew:s'GOSTL'MLNT FEACCE Ie t.t-r-1.1 '
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 nee for homestead fraud homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2019 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reeeise the
benefit and to provide additional identifying information nectars'to allow county government to better monitor homestead
filings.'Ellis information will he kept confidential and can only be aecexed by authorized county officials.The Bepanntent 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
Hulfachor, Don E/Connie K
RI Box 49 A //'',1D
Patoka IN 47666 I
352
Don E/Connie K Hulfachor 4,/
5191 N 200 W State Parcel Number Legal Description
Patoka IN 47666-9043
26-04-11-300-001.445-018 010-01445-00 PT SW 11 1 11 9.255 AC
t ii I I t It II tat I I tar I I ii t I n I I nn I ieI n I I t I I 11111111
• PART 2: TAXPAYER 1NFOR%IATION
Owner I First Middle Last
0 Wes
ng Address(number and sucet, state,and ZIP code]
5/ 9 / N C,0 0 ul lO creep /r r i-P7 4k
/
Spouse First Middle ' Last
s
(CNN/F k' /7/1/A/-4 NOie
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
S/7/ /v 200 [1/ /,9Tn4 LN• 4/ 7fl4
PART 3:CERTIFICATION
Each undersigmed 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
•