Homestead_Williams (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Loral Goverment Finance
INSTRUCTIONS: See reverse side for riling instructions.
P0
FORM YEAR
10
r
I (We) / certify that on`Lhwllst d��March, 20
(We) occupied as our principal place of residence the to described real property for which a Homestead Property Tac &dlt is eby daimed:
�(We) owned El Are buying under contract GIBBON COUNTY AUDITOR
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.
: ``• r "� • � i° la ate eCONTRACT RECORDEDs ''^ %5'- s". rKi3df'- 6k�' . 12
._ - .�.i:sa e...�, fii- `,ice': ;•-
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
``r`r3"'z` M mar z '. +'L_k .' Pis -5.;. P.ROFERTXDESCRIPTION?`���- -S. 'a3�?�� *�'e- ''�r�•.; sin :3ir��ts-+,x(�:
County p T 'a t(' ,township)
Parcel number jLlegal scripti on Is the propelty m question:
/ - - eel proper' ❑ Mobile Horne (I.C. 6- 1.1 -7)
H any potion 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 any b produce irrcortta.
G.Q3x
-,4 -d-&O - cn /.l9 -aa/
v --`,`- .' •-rB +,lyre :,ur -
�F-- ��•,��-- _._.�P.ROP,ERTY,OWNED`BY CIAIMANT;IN:OTNER'000NTIES
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
of cla" ant
Address (number and street, city, state, ZIP code)
ASSESSOR USE ONLY t1 r-�
, TRUE TAX=,
'- mow„VALUE w,"
ASSESSED VALUE
AT 100 %OFTTVyAm
HOMESTEAD e
VALUE S
• r a
NONRESIDENTIAL
VALUE` -`V.>
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
y,-.4r
Total land (line f plus line 2)
(3)
'Residential
Dwelling
(4)
?,zw� - :,
�#�E
Improvements or Annually
Assessed Mobile / Manufactured Home
Gara e
g tic
Y
Other improvements
(6)
Total improvements (line 4 through line 6)
(T)
Trial value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
-20- IIM �' =..rax R�- �#—'j- yr°" ax,` .STANDARD:'DEDUCTION'ALCOWANCE, ?- 3kg",�i?R;ova;�i:ivg�'a'c
_Pay 20_
Lesser of 112 Homestead '
valuation or 535.000 $
Signature of Auditor Date signed
SIMLE FORM!!!MIR_I■rv1 TRFASURIA NORM 73-IA
APPROVED BY SIAM BOARD OF Arff*ISTS.et PRIVtPIRED BY ntr DrPMne.Tcw LOCAL Caw<RYMENT FINANCE M 4I.1.2:4.1
Gibson Auditor
• 101 l N IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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 eser for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
•
HEA 1314-7009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to receive the
benefit and no provide additional identifying information necessary to allow county government to better monitor homesead
filings.This information will be kept confidential and can only he accessed by cut red mnnt rial'he Dv-pannier,'of
Local Government Finance will use this information to create tools that will It-p �ais I one 11 ate,humcstcad fraud.
PART It PROPERTY INFORMATION
Taxpayer Name Property Address
Williams, Brian W/Mary A C ,31 //j(/ 60
Fort Branch r :/
8700 0�
Brian W Williams
5744E 750 S State Parcel Number Legal Description
FORT BRANCH IN 47648-8445
t o uII 111111111111111111111111111111111111111111111111 26-20-18-300-001.191-001 001-01911-00 SE SW 18 3 9 6.23 AC
D10
L
PART 2: TAXPAYER INFORMATION ••
Owner 1 /q/f / First wfirtiC Middle to l t/,mS Last
aline Address(number and sweet,city,state,and ZIP code) 0 Same as propem address
57q(i E 757 3 60- 6&meti, //V 1126 0
Spouse First Middle Last
in/9g/ gI,I&UST/J a)/60/0725
Mailing Address(Number and sweet.city,state.and ZIP code) ❑ Sande as property address
5,1/V 6 75-61 S 6gr RAJ /1 g76(t
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( -.mat Date
•
� l Y7 j-'FY.;o/u- /' U/t/mil/ /� /l il //61/111.V
yr�. U i //(. G itz- 4'l G itte:/ °y
I /•