Homestead_MasonCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
3! CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R2 / 592)
r4.
INSTRUCTIONS: See reverse side for filing instructions.
I (We) paz�; PX /k 1 a Sdrw certify that on the 1st ,,dam�''�-qf Ma
•'occupied as our principal place of residence the following described real property for which a Homestead Property T e�jt i FlerAe I
(We) owned ❑ Are buying under contract UUUUUU ����qqQ
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buyhtl4utgeAa Ad act.
CONTRACT RECORDED - -�; .: ,�,,1•./',f,�Tr1�
If buying on contract, Fee Simple owners name ti��'d +: • t '
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
Counry
T m
� - 2
'Taxing distpct_(
County
�Gvt�Gle_
eby certify i e abo statements
/7711
Parcel number
O /O-DO - o 0
Legal description (( ��
7/� O - / — /
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. ,
a ��
ASSESSOR USE ONLY
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
eby certify i e abo statements
/7711
a true, rrect and mplete.
Signature of claimant _
dd numberan street. city, state, ZIP 9Ket/^
QV
a ��
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 plus line 7)
(S)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
" - STANDARD DEDUCTION ALLOWANCE
- -
19_Pay 19_
Lesser of 112 Homestead
Val triton r $2,000
S
Signature of Auditor
Date signedn y/
"I- O
A'
SLATE FORMSx tCILAM MIASMA FORM:NIA
.AITROVEO BY STALE BMADnrnna2aS.bit PIL9[Rmm BY 111E DEPART CYr OF LOCAL GOVEILYMEA7 FINANCE IC 1.1.1-124.1
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 net for homestead fraud homestead fraud causes higher tax bills for all:therefore.
• HEA 134-63009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to teethe the
benefit and to provide additional identifying information necessary to allow count'eovernment to better monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Depanment of
Local Goverment finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Mason, Daniel M/Shirty A
RI Box ISO A
Patoka IN 47666 3
192 I
Daniel M/Shiny A Mason 1
R1 Box 180 A State Parcel Number Legal Description
Patoka IN 47666-9218
26-05-20-300-000.926-018 010-00926-00 PT NE FR 20-1-10 5.589
I.I..1111111 II..uIIu,illiilllritililitilllttlitill iiille.I.IEI AC D-12 C-1
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
-234 N/L'A /W Ant ASo N
Ong Address(number and street,city,stare,and ZIP code) .S5me as property address
/133 rc c9o.Al i°4rokA )) XE- `-/76,x6
Middle Last
-D CER5%)
Mailing Address(Number and street,city.state,and ZIP code) ❑Same as property address
Social Security Number(last 5 digits) I Driver's License/State ID Number (lasts digits) Other(please specify in Pan 4 below)
State
.
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 1 Signature Date Telephone
,0�,.;P� ,y11 -- y-6-70 (&/z ) 7 7 9 -„Z y s7
Spouse Signature Date Telephone
)
PART 4:ADDITIONAL INFORMATION
•