Homestead_Kolb (2)CLAIM FOR HOMESTEAD PROPERTY TAX - FORM YEAR
CREDIT /STANDARD DEDUCTION HCto
State Form 5473 (R2 / 5 -92) i
reu
INSTRUCTIONS: See reverse side for filing instructions.
InA
CERTIFICATION STATEMENT r ^
°re) _ _ certify that o e 1st day�.Mar t9 _
�) occ,pr a>�pnncipal place of residence the following described real property for which a Homestead Prope x r��brfoR aimed:
(We) owned ❑ Are buying under contract ' - I .
❑ 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
Town h I
Town
County
Taxing district (c , t w 7ownsh )
I
Parcel number
Legal description
Address (number and street. dry. slate. ZIP code)
Qjo -QQa99
Signature of Auditor
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
teby certify the above statements are true, correct and complete.
Signature of daimay
1
Address (number and street. dry. slate. ZIP code)
Signature of Auditor
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)
Valuation or $2,000
Signature of Auditor
Other land
(2)
Date signe —
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 plus line �)
(g)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
'tying 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 signe —
STATE FORM TAN.TIC I ATTN. T1A5UI1AFORM 73-IA
.APPROVED at AVt NAARODF AT ANuri._ur PRFSIWPFD BY nu DEPARTNENT(w LOCAL IXN20.YMrnl FINANCE IC N.14!-!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 caul s higher lac bills for all:therefore.
II HEA 1 344--2009 requires taxpayers who receise the homestead standard deduction to verily that they arc eligible to Iceehe the
benefit and to provide additional identifrine informaton necessary to allow county government to better monitor homestead
filing4.This information will he kept confidential and can only he accezed by authorized county officials.The Ikpanment of
Local Government Finance Bill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Kolb, Tricia A/Karon S Anthis
Stewart Rd (�Y1L,
Patoka IN 47666 V�
991
Tricia A Kolb/Karon S Anthis
5213 N 75 E State Parcel Number Legal Description
Patoka IN 47666-9165
ltllt tllttt ltl'ttI 111 urllttirlIttl 111111 trt11t 1tttt ll ttllttlll ti 26-05-58-024-000.299-018 010-00299-00 PT MD 24-1-102.40 AC
x
PART 2:TAXPAYER INFORMATION .
Owner I First Middle Last
'RIP1A A- Koz-B
__ •g'Addki(number and iticct city,stares-and ZIP code) - _-- - — — — -E Same as propeny midress—
SA I S N 15 E P4 70/Cn i.y// 717(o(0(0
Spouse First Middle Last
N/ Fr
Mailing Address(Number and streek city,state,and ZIP code) El Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
star
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
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