Homestead_Mrv Investments IncCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (RS/4.03)
Prescribed by the Department of Local Government FinaAC,
INSTRUCTIONS: See reverse side for
FORM YEAR
FIC10
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I (we) / certify,0 anon the 1 st day of March, 20_
(We) occupied as our principal place of residence thlJollowirildescribed real propjfor ata Homestead Property Tax Credit is hereby claimed:
El I (We) owned El Are buying under contract
Have a beneficial interest in the entity hat is liable for the roe taxes on the roe
ty property ftY property rty and that owns Die property or is buying under a contract.
�x'< �', �.s a. l',' t' �zCONTRACTRECORDED ?:",'':r�s1t3�arf- 5`k 1:. - �s
If Eying on contract, Fee simple owners name
Recorders Ofice where contract is recorded Record number Page
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qty
Tomship
Taung di s ' (' , town, to P)
Parcel number
Leg descriptions" � Is the property in lion:
w �-1-� Real property ❑Mobile Home (I.C. &/.1 -�
H any portlon 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.
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' i8,�_SSESSOR USE�ONLY
TRUETA)!C
County
Tmnship
County jTwnship
I hereby certify the above statements are true, correct and complete.
Si at a of 1 ant
Address (number and street, city, state, LP code)
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'A53ESSEDa/AUIE
*HOMEBTEiAT `
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t NON�REBtffi' f
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Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
v
Other land
(2)
�,_Zr.$•
Taal land (line f plus line 2)
(3)
(4)
r �`- ��'� °�'•'"'�"��"•''"��'`
Residential Improvements or Annually
y
Assessed Mobile / Merttrfau9lred Hone
Garage
(5)
Other improvements
(6)
;n'= •'.�q-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is We, coned, and
Signature of assessor
Date signed
complete.
Veifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Valuation or 535.000
Date signed
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APPRrnt➢ISaf'_Smite Or L((WM...SM nWYRsgo U\nu:mnS,MGTa LOCkLGOVEAS MST IPC.CLrct-:.14-s.t
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 incentive than ever for homstcad fraud.Homestead fraud causes higher in hills liar ell:therefore.
• HEA 1344-209 requires lacpayers who receive the homestead standard deduction to verify that they am eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kepi confidential and can only be accessed by authorized county officials.The Depanntert of
Local Government Finance will use this information to erdate tools Mai will help counts'officials eliminate homestead fraud.
PART 1:PROPERTY INFORMATION-'
Taxpayer Name Location Address
Mry Investments Inc
3660 N 225 W
PATOKA IN 47666
435
Mry Investments Inc F.111111 II If let mil II�II�011�11_II_I0111111111111 1II1111 III 11111
2660 N 225 W
Patoka IN 47666
State Parcel Number Legal Description
26-04-23-300-002.047-018 PT E SW 23 1 11 1.9249 AC
0
APR 11 2012
GIBSON COUNTY AUDITOR
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 —2" R'11 First Middle //����/] v'y/JI//) Last
Mailing Address(number and street.city.state.and ZIP coder ❑ Same as property address
Last
0
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's LicensciState ID Number (last 5 digits) Other(please specify in Part 4 below)
I I I See
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
0
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date
PART 4:ADDITIONAL INFORMATION