Homestead_Coxe� CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HCtO
. , • State Form 5473 (R215 -92)
u
INSTRUCTIONS: See reverse side for tiling instructions. - . - - _
re _ - ce that on the of M
) occupied as our principal place of residence the following described real property for which a Homes nr Cro
(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 trying on contract, Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
° PROPERTY DESCRIPTION
Township
Cou
I �n
Township
eby certify the above statements are true, correct and complete.
Taxing district (city. town,
township)
Parcel number
0 o - o -cc)
Legal n
+ E� s 0 a3
�15
If any portion of the residential structure or the land not exceeding one (1) acre that immediatety surrounds that structure is used to pr cece income, describe the use and portion
of the grope utilized to p oduce income.
Total land (line I plus line 2)
(3)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
Gounty
Township
eby certify the above statements are true, correct and complete.
Si", re of claimant
Sign cure t Auditor
A ress (number and street, city, state, ZIP code) _
Other land
ASSESSOR USE ONLY
TRUE TAX
-VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Sign cure t Auditor
Date sigrnQ —
Other land
(2)
Total land (line I 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 jobs line 7)
(a)
I hereby certify the above is true, correct. and
complete.
Signature of Assessor
Date signed
V,,i ing action - Signature of Auditor
Date signed
Mr
STANDARD DEDUCTION ALLOWANCE -
19 _Pay 19_
Lesser of 112 Homestead
Valuation or S2,000
S
Sign cure t Auditor
Date sigrnQ —
SIAM£FORN!!WOP:Owl TREASURE"PotM 731A
APPROVED BY St TE BOARD OF AmIVII\TL:Vw P!r_ARrmal'THE DEPARTMENT OF LOCAL roVER.YMEA'I MPA\'CE IC -I.1-2241
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 ewer for homestead fraud.homestead fraud causes higher tan bills for all:therefore.
g HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
n `,; benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
qY@ )))}'
filings.This information will be kepi confidential and can only be 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
APR 1 4 ZULU Taxpayer Name Prof - Add
Kell, Arllette
‘71040, N R I Box 34 lb
GIBSON COUN : .I •R Patoka IN 47666
75 14
Annette Kell ,9-,_ —
R1 Box el L.¢�-�w'� State Parcel Number Legal Description
PATOKA IN 47666-9025
26-04-23-30 02.230-018 010-02230-00 PT E SW 23 1 11 .75 AC
IIIIIIIIIIIIIIIIIIIriiIIIIlrlrrlllllllllllllllllllrlllrrrrllrl C-1
This form MUS se returned to County Auditor's office. /
Please • • e - • s orm back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
Owner 1 k First Middle L Last
_ A r l l e.--V c Ma,r i ei'1 c_ Cox ( ,roe/.
lila
Address(number and street city,state,and ZIP code) I�[� Same as property address
N . as5vl
Spouse First Middle Last
Val 11 \ i am C u.rl-i s C o x
Mailing Address(Number and street,city,state,and ZIP code) Ni. ame as property address
3' 4k N N . as 5 W •Ica .
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