Homestead_NovotnyCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hc10 LP��
State Form 5473 (RS / 4-03)
Prescribed by f7ro Department of Loral Government Finance 1� T
® INSTRUCTIONS: See reverse aidio b l8p rafticd= {'�-� ){ ; T U
1 (We) certify that onPte fst day March. 20_
1 (We) occup d as our principal plaVof Usidence tHe following described real property for which a Homestead Property
Tax Credit is hereby daimed:
(We) owned El Are buying under contract a �✓O,
eve a beneficial interest in the entity that is liable for the property taxes on the property and that owns the - property 6r1d- b6yirigAiriadT913ontract.
w11g, `i�. - „3.�e .rte? r` a: > C'g— jMN"4 -0v C NTRACT::RECORDED
-- +,e z�i~�t� -rte., °:' �.:, 3, �• :`:i�3.�..rY''�fi�*:v'.�`.��§”.
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
a}= €w
O;OE r -1i -60
SCRIPTIONVO&egX M : x.
County
Township
Taxing district (dry, town, township)
Parcel number 7�
b
Legal de 'ption Is the property in question:
'4 iny]y
C�rteal property ❑ Mobile Homo (I.C. 6-1.1-7).
If any portion of the residential strucure or the larld 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.
��- QS- S� -Gb1�- Sao• `d�� oil
n. �''' ���`.," ��'''.' ?:„` 'PROP.ERTY,OWNEU;BYCL'AIMANT,IN OTHER "COUNTIES �i'.<:. 4''ttaryi.T'-?.'.r&',i�?¢�tgo.°3
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signatu claimant
Address (number and slreet, city, state, ZIP code
�`UONLY- §
TRUE TAXI'
�yVALUE
rASSESSEDVAI.UE
AT 700 % -AFTTV
jaHOIAESTEAO ,`'7NON-
�rVAL'UE?
RESIDENTIAL h
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
'Nil -
Total land (line 1 plus line 2)
(3)
Rrlsiderttiallmprovements or AnnuaOy
Atlseaaed Mobile I Manufactured lot
Dwelling
Garage
(4)
t"�'.oAl'.L- :bra"'` •..!'
RAW
Other improvements
(6)
v
RW
i:�er.Z$
Total improvements (line 4 through line 6)
(T)
Wvalue (fine 3 plus line 7)
(S)
hereby certify the above is true, coned, and
complete.
Signature of Assessor
Date signed
Vadfying action . Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
vauaaon or &35.000
Date signed
J STATE IIRM lift.ile U t.J) ThEASSMQ FORM 73-IA
APPROVEf BY STATE MVtOnr!/M1R:'1S.21"n PRIAltIDED BY fill DEPARTM£MT IF LOCAL CAV_R.VMR.'T Fn:ASCE r VI.I-I.4.1
Gibson County Auditor
101N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and flurried couple,. are limited to one homestead standard deduction. As the receipt of this deduction becomes
more beneficial.there is more incentive than emcr for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
® HEA 1344-7009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reecho the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and can only he accessed by authorized courtly 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
Taxpayer Name Property Address
Novotny, Joseph P/Cassandra Lee
R2
•RINCETON IN 47670 •
996
Jos P Novotny
5 0 N 75 E State Parcel Number Legal Description
ATOKA IN 47666-916•
lullutltllntlintllti�rinntIltllntlnitlnllit ttlrtt ll 26-05-58-026-000.854-018 010-00854-00 MD 261106.40 AC
D-12 C-1
PART 2:TAXPAYER INFORMATION
Owner 1 / First Middle Last
ri0 SC•eq Pirrit .110 LI nra/V
_ ng Addleso(number riodstreetceity,state,and ZIP code)
.® --
&Ivo Al -7Ce Atom /A/ 17466-914y
Spouse First Middle Last
GAS 54N0,24 Aft No(/eTi✓,/
Mailing Address(Number and street.city,stale,and ZIP code) I—✓I Same as property address
Q-140 M 1St 94r°K4 /4 417 MG 4. —g /tom/ JW
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.
Own ignaturc Date
FART 4:ADDITIONAL INFORMATION