Homestead_AdamsaA i CLAIM FOR HOMESTEAD PROPERTY TAX
rf CREDIT /STANDARD DEDUCTION
..":'; • State Form 5473 (R2 t 5 -92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM
F°j -
M nY 10199'
as our principal place of residence the following desckibed real property for which a Homestead
YEAR
�3
of March, 194--
is hereby claimed:
7 J(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 -
If 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 descriptio
S nature of im
Address (number and street, city, state, ZIP code)
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. -
Otherland
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
Coumy
Township
County
Township
certify the above statements are true, correct and complete.
S nature of im
Address (number and street, city, state, ZIP code)
ASSESSOR USE ONLY
-
TRUE TAX
VALUE
ASSESSED
VALUE_
HOMESTEAD
VALUE
NON - RESIDENTIAL '
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
_
Otherland
(2)
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 plis line 7)
(g)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
action - Signature of Auditor
Date signed
DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
Valuation or 52.000 - $
iTAtE FORM!iW.Y'Nt-lu, IR ASURLR LOLM 6t.-5
APPROVED RV aE IO\ROOF.'AIU VI5,y4 MSCRIHEDLII Mt OEPARIME'T OF LOCVAOVELMLC1 ILCC(i IC blb_fl
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one honles:ead standard deduction.As the receipt of this deduction becomes
Princeton,IN 47670 more beneficial.there is more incentite than ever for homestead fraud.Homestead fraud causes higher lax bills for all:therefore.
7•�
If EA 1344-2009 requires taxpayers who receive the homestead standard deduction to serify that they are eligible to receive the
�
� benefit and to prmide 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 crate tools that will help counts'officials eliminate homestead (mud.
PART l:PROPERTY INFORMATION
Taxpayer Name Location Address
Adams, Kenneth D I /Merry
10285 W 850 S
OWENSVILLE IN 47665
666
lfeflrteiW 850 Srry Adams l I II If 11 I�CIII/11/11 fll1111 IIICIII OIlIIM1111111II 111111 III ft CIIDIll CII CI II
10285 W 850 S
Owensville IN 47665-8854
State Parcel Number Legal Description
26-17-28-100-000.001-021 PT N NW 28-3-12 1.77 AC D-20
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.
• • m• . • rx
First Middle last
r E-g y 1 net n-m
Mailing Address(number and street.city,state,and ZIP code) Easrne as properly address
Ina. VS tit • 25os OLuensv ‘ Ile, I/,. 4-7665
Spouse First Middle Last
Mailing Address(Number and sleet.city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's LicenseiState ID Number (las:5 digits) Other(please specify is Pan 4 below)
I I I I I sae
• PART 3:CERTIFICATION
Each undersigned cenines.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.
(truer 1 Simamre Date
•