Homestead_PeilF_
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD If SUPPLEMENTAL DEDUCTION
State Form 5473 (117216-09)
'O Prescribed by the Department of Local Govemmem Finance
INSTRUCTIONS: See reverse side for filing instructions.
V0
FORM YEAR
HC10
T T
1 i
M
CERTIFICATION
I (We)
certify that I (vJ'epcupRd 8, r20o@r) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ 1 (We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
GIBSON COUNTY AUDITOR
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of claimant (legal name)
Soda] Security number of claimant (
Social Secanty number of claimant's spouse (last five digits) Drivers license I Identification I Other number
Issuing Stale
of claimant's spouse (last five dgits)
CONTRACT ••r r
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
Court
Township
Taxing district (city- town 11D)
OS —5 d J —WO
Pa nu
Legal description
Is the property in question:
❑ Real property ❑ Annually assessed mobile home (IC 6.1.1 -7)
If any portion of the residential stiuchum or the Land not exceeding one (1) acre that immediately surnxi ds that structure is used to produce income. describe the ttse and portion
of the property Crazed to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County
Township
I hereby certify the above statements are true, correct and complete.
signature o
aimant
tVYYt
Address (number and street, City, stale, and
y
'
O
ASSESS I OR •
ASSESSED
D% OF TTV
• mom • r
Land not exceedirg 1 (one) acre immediately
su...atn residential im rovements.
nd
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential Improvements or An nual lY
Dwelling
(4)
y• -j1'3- _. Iz
Garage
(5)
,yNr �; <
3 {•3
Assessed Mobile I Manufactured Homer
Other improvements
(6)
Total Improvements (line 0 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
STANDARD • r
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or 545,000
NohviNstandirg any other provision, the sum of the deductions pmvded in IC 6- 1.1 -12 to a mobile home that is
5
net assessed as mal property or to a manufactured home that is not assessed as real pmPerry nay rot exceed
(12) of the assessed value of the mobie home o manufactured hone.
itor
Date sgn ( In day,
1 i
M
STilE RAM! ).Mown 1 RrASI:ErA FORM MIA
ArnRrwen BY STATE BOUMor MYTILTS.b.n PRISTIBED BY THE DEMMTIEYTOr LOCAL CO%TR.YNFAT FB:,&WE Ms-LI-224.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couplets 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 ml bills for all:therefore.
• HEA 13-14-2009 requires taapaers 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 be kept confidential and can only be accessed by authorized county officials The Department of
Local Government Finance will use this information to create Ws that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
F I Taxpayer Name Property Address
L E D
Pell,Adam D
L $� la6 C Steelman Cl Road
APR 7 LULU Hazleton IN 47610
276
Adam D Peil d"r /Oel £,Ite-atinonel R
cb
augea443103171reOUNTV AQBITQR State Parcel Number Legal Description
PATOKA IN 47666-9106
tit t �tl t��tt�trt�tt�t
iaittllttt1t11tt t11ttt11tr1t1llltt � �� 26-05-58-039-000.151-018 010- 00151-00 PT MD 391-101 AC
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
Ili,.Address(number and street,city,state,and ZIP code) ame as property address
Spouse First Middle Last
1-Acx-NiThcah
Let Tei
l�,
Mailing Address(Number and street,city,state,and ZIP code) Er game as property address
-
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 Signs ^� Date
PART 4:ADDITIONAL INFORMATION
•