Homestead_McCainCLAIM FOR HOMESTEAD PR OPERTY TAX FORM
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
YEAR
I (We) - ) VTI rc-% 1 ' I- Is — LO 5-A rtify, th qthIlAay of March, 20
1 (We) occupied a ur principal place of residence Bon
the following described real property for wh& a HO& a Property T&( Credit is hereby claimed:
(We) Are buying under contract
APR � 5 'M')
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.
on contract, Fee Simple owners name
Recorder's office where contract
Record number I Page
9; ,.v,7- "`,. d.;.` L P R 0 P E RTY. IDE S C R1 PT116 IN
l-?
County
Tomnship
County
Tact di Icily, I I O
) 1\ J () T
I hereby certify the above statements are true, correct and complete.
Parcel number
Legal description
Is the property in question:
Land not exceeding I (one) acre immediately
3�D :� - q)
j
F-1 Real Property
❑ Mobile Home (I.C. 6-1.1-7)
If any portion of 6e residential � structure nr tits
am that immediately surrounds that structure is used to Produce income, describe the use and portion
of the property utilized to produce income.
Otherland
(2)
k
5;9 —
PfkdPtRTY;CiME6BY.Ci�AJMAkT-,fWOTi4ER�COUNTItS-
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SSESSEDNALUE
County Toomship
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
aress (number and street, city, state, ZIP code)
TASSESSOR USE:CIN L -�t '�"
72
TRUE TAX
I ge�
SSESSEDNALUE
,,HOMESTEADt�
I NONAESIDENTIAL-nv
M
Valuation or 535,000
AL:Y _k�M
00W, JTV
DF
Date Sig
-3"WALUV r.
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Otherland
(2)
Total land (line I plus line 2)
(3)
Residential Improvements or Annually
Dwelling
(4)
Assessed Mobile I Manufactured Home
Gars e.,
(5)
improvements
(6)
.V461,
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD, DEDUCTION' ALLOWAINCE-4. ... ....
20 _ Pay 20_
Lesser of 1/2 Homestead
Valuation or 535,000
S
Signature of Auditor
Date Sig
•
STATE[(550!.!.`4113P-I V1 IMwRLR}OP.0 IS-IA
AMC.%EDill TUE 1O■Res OEUgiNK.yM IRIM'RIHLD RV IIn.!LPARlMLTOFLOCALCM LA\MRCI 1L •CE ICbI.i 1241
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS.. •
101 N.Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
Princeton.IN 47670 more beneficial.there is more irecntiee than ever for homestead fraud.Homestead fraud causci higher lac bills for all:therefore,
DEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
® F I L F7 D benefit and to provide additional identifying confidential information n my be to allow county government to barer mmimr homestead
filings.This inlor provide
will be kept confidential and can only be:xre,sed by authorized county officials.The Department of
Local Government finance will use this information to crone tools that will help county officials eliminate homestead fraud.
PART I:PROPERTY INFORMATION•
Taxpayer Name Location Address
MAY 7 Zns'
_ McCain, Jean
C.J.M..7::: 5841NUS HWY 41
476
�-\V\ PATOKA IN 47666
GIBWAN COUNTY AUDITOR ,
Jean McCain HOI/II L11ll0111 LIIli /II II Elm I1 II ii/Iil]ii-iiiHII_I1100 /VIII[II Ell II
5841 N US Hwy 41
Patoka IN 47666-9100
Il' 'iIlI'IllI"'IIII11I1IIIt1llllllll"IIli'I1IIhlIllIlIlIIIlltl State Parcel Number Legal Description
26-05-18-400-000.327-018 PT E 18-1-10177.40 AC 0-12 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:TA\PAYER INFORMATION,_ _ -
—
.er I First Middle Last
3-114 IC 4e c--c
IN
Mailing Address(number and street.city,state,and ZIP code) Same as property address
Sbill AJ us fluty 4r TAfokt- A) u 7(,, 6 (449
Mailing Address(Number and street.city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's Licenser-State ID Number (last 5 digits) Other(please specify in Pan 4 below)
I I I I sore
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.
Own4 I Signature Date
( )
i. PART 4:ADDITIONAL INFORMATION
•