Homestead_Riley (7)n. >• . CLAIM FOR HOMESTEAD PROPERTY TAX
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CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
FORM
(1)
1991 Pay 1992
19 — Pay 19
HC10
(2)
QYEAR
I�
Lesser of 112 Homestead
I '(We V �' certify that on the 1 st day of March , 19 a
it` /We) occupied as our principal place of residence the ollowing described real property for which a Homestead
roperty Tax Credit is hereby claimed: `B'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 it 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 Tow*i I T i g istr ct (City, town, township)
- .
Parcel Number Legal iption
to \ -o I , IJ(1,J Sw 3 -3- a.os L
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County —_ Township County _7`0_ wnship--
hereby certify the above statements are true. correct and Signature
Address (Street,
state
ASSESSOR-USE ONLY - TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Other land
Total land - line (1) plus line (2)
. Residential improvements Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
(1)
1991 Pay 1992
19 — Pay 19
Lesser of 1/2 Homestead
(2)
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
(4)
Signature of Auditor
(5)
Date Signed
(6)
(7)
(8)
1 hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19 — Pay 19
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or $1,500
Valuation or $1,500
Signature of Auditor
Date Signed
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STATE FORM MNne/ C MIASMA FORM 71-IA
.VIRD1'ED Or Snit BOARD Or Art filiN7l.2t,4 rtIs(T1Bm or mrorMARnnrTtF LOCAL G ass1rwT rauANCEICVEt4'-11
Gibson County Auditor
•101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 individuals and married coupls 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 tax bills for all:therefore.
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HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recehc 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 accessed by authorized county officials.The Department of
Local Government Finance will we this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Riley, Robert P/Peggy S
— "1 'I -122-A-.
Oakland City IN 47660
3234
Robert P/Peggy S Riley
Oakland City IAN 4`7660.8531 State Parcel Number Leal Description
I tltt lltttitIlttt 11tt11tt rit tlttlt lttt11tt tt11tt11ttltlrtt ltll 26-20-03-300-001.465-001 001-01465-00 PT NW SW 3392.05 AC
- - - —- - - —— — — — -- X - — ' — -- ...
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
/>
lbw Address(number mid strut city,state,and ZIP code) Same as pro my address
,��3,f k 4 /C'737 %46d 1/v / 1747,il
/
Spouse First Middle Last
A c;7 / c SUS ,47/
Mailing Add 4(b/ fiber and street city,state.and ZIP code) Same as pm ny address
549l. 1l S7s—� g 0/11 // - / rz J
— _____
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 '
.A.� : '.... o
PART 4:ADDITIONAL INFORMATION
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