Homestead_Yorks CLAIM FOR HOMESTEAD PROPERTY TAX A-,,- RM YEAR
CREDIT /STANDARD DEDUCTION 0
?. l.° State Form 5473 (R2 / 5 -92) � �E
INSTRUCTIONS: See reverse side for /fling instructions.
. ""CERTIFICATION STATEMENT: -? '._E.;�`'..j .°
I (We) 4unr cer�ty that on the'1st_day of Match, d9_
I (We) occupied as our principal place oe the following described real property for which a Homes" -P operty -Tax Cred tis. heeby.j/ aimed:
�`' GIBS^vt,l C�:17::TY AUDITC
I (We) owned ❑ Are buyinntract
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.
- - - t -. CONTRACT RECORDED - _ _ • t _ h _ - _ _ 'a .
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION -
County Township Taxing district (city, town, township)
Parcel number _ Legal descrip� n / — —'
- E'oZo2g�Ti' L AL
It any portion of uiv residential structure or the land not ex eding one (t) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
oil- OY= //- ToD - OOo3.�0�� O /dam
. PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
NON-RESIDENTIAL. ;
VALUE
Township
I hereby certify the above statements are true, correct and complete.
Signature
claimant
Mess (number and street, city, state, ZIP code) -oe I nvt-
5'3
(2).
K&
- ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL. ;
VALUE
Land not exceeding t (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2).
p3i'•
Total land (line 1 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)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
verifying action - Signature of Auditor
Date signed
STATE FORM,350.In/HMI IRE1SLIMR FORM 11A
APPROVED
IMPORTANT NOTICE TO HOM STEADEP GOVERNMEAT FINANCE It z
Gibson County Auditor
101 N Main
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 nee for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• FIFA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county gm ernnlent to better monitor homestead
filings.This information will he kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance sill use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
York, Robert W/Dawn M
RI BOX 53 A
Oakland City IN 47660 2 ,
65 J /
Robert W York /1�lA'�`/
1631 W 550 N State Parcel Number Legal Description
PATOKA IN 47666-9050
�t�tt��ttt�t�� �ttt��t t�t�tt��tt tt�t�t�� ��tttt��tr��t� 26-04-11-400-002.285-018 010-02285-00 PT E SE 111112.5812 AC
ttt I
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 •
--pit:1 be }- 4-- Weuvota V o‘r K_
Ong Address(number and sweet,city,state,and ZIP code) ❑ Same as property address
f (p 3 ± k) 5SoM CEOk TM . 47(066
■
Spouse First Middle Last
Aw 11 M aI-( nee yes r ....__
Mailing Address(Number and street city,state,and ZIP code) ❑ Same as property address
I � 3 ( v.) 550 iNi . p _.-I-0 1<c,
----_- - _
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 1 Signature Date
/
PART 4:ADDITIONAL INFORMATION i
0