Homestead_WorkmanCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
=E CREDIT /STANDARD DEDUCTION _ HC10
. % State Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side for filing instructions. *. ` • �� !� -
certify that on the J�t d4qLp4ah, 19
J •; J
I (We) occupied ur principal t e of residence the following described real property for which a Homesteari'PiopeQjDj"63 gereby claimed:
16 1 (We) owned ❑ Are buying under contract -
❑ 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.
CONTRACT RECORDED
It buying on contract. Fee Simple owner's name -
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township
-.
County
Taxing disVict (cif ,town, taw ip) -
w
Parcel number
Legal d do
�
-7
010 -00 5 3
S
- - 10
It 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.
SignatufJol Auditor �� y� g DIM, —
` 61" r"\ ,
Total land (line I plus line 2)
• PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
aunty
Township
County
Township
eby certify the above statements are true, correct and complete.
Sig a ure of daimant
FA;�?:es� (numlmr a nd sveeC City stacode)
-� � Cb f if /O N
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON -RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
S
Other land
(2)
SignatufJol Auditor �� y� g DIM, —
` 61" r"\ ,
Total land (line I 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)
(g)
I hereby certify the above is true, correct, and
�plete.
Signature of Assessor
Date signed
-.fying action - Signature of Auditor
l
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
S
Valuation or S2,000
SignatufJol Auditor �� y� g DIM, —
` 61" r"\ ,
11 >; W
•
MATE FORM 539.9.R.: -O'I TREASUIEa PORN 711A
APPROVED BY<TATE IXs oorern l s. PPIAMBEDnv IDE DEPMT '4FOF LOCAL CASBLNMCFT PP:niCE 1CH.13'-!.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 eter for homestead fraud Homestead fraud causes higher tat bills for all:therefore.
HEA 1344-20119 requires taspa'ers who receive the homestead standard deduction to verily that they are eligible to receve 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 be acre.sed by authorized county 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 LCFORMATION
Taxpayer Name Property'Address
Workman, Judy
—
680
Judy Workman
5162 N 75 E State Parcel Number Legal Description
Patoka IN 47666-9166
26-05-58-025-000.853-018 010-00853-00 PT MD 251-1073.77 AC
ii rrr
D-12
PART 2:TAXPAYER 1NFORNTATION
Owner I First Middle Last
�uJs/ AuN WoRkmAA3•
• •g Ad (nu ber
and street,city,state,and ZIP code)— _ _ _ __ —
t1 �1-Stone as proper addrs —_ __
5/ , 7S� n1oXR , '/'74Ge
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sus
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 Signature Date
PART 4:ADDITIONAL INFORMATION
•