Homestead_Pemberton alAtE rORM!lMINV, , 1RE UADI FORM 75-IA
.\MRT'EO BY NAIL WARD Of MYT Nf.inn rtrsRtBFL BY i11E DEPART ecr(IF LOYAL COVED/MINT FINANCE WAI.I-Dal
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples arc limited to one homestead standard deduction.As the receipt of this deduction thrones
- more beneficial.time is higher more incentive than ner for homestead fraud.Homestead fraud causes high as bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This infmmatinn will he kepi confidential and can only by accessed by authorized county officials.The Depanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Pemberton, David R/Deborah S
R2 Box
Ilauhsadt IN 4763
11006
David R Pemberton
_-_ 1222.9 S 200E __ - - State Parcel Number Legal Description -
HAUBSTADT IN 47639-7973
' I I I I I I I III I I I I I I I I III 26-23-16-100-001.973-024 004-01973-00 COUNTRY AYRE EST#2
to utl nn front tuutn nut faun X
LOT 4 D-9
PART 2:TAXPAYER INFORMATION
Owner I .P '\ I First Middle / Last
, vld ►0hv-1'c-n-7
tg Address(number and street,city,state,and ZIP code) -- / Same assns proper iddiess - —- - -— --
/ 2_2-21 .4 zoo 6- fta '/ 5 ti I Tfr(cd X7639
Spouse First Middle I_ Last
T1orC1 S re 441 h.49v��rsvl
Mailing Address(Number and street,at',sate,and ZIP code) Same as property address
( ZZq' Zoo - E - 7{rvd-5a .� -retci — 976-3
v
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
unlau ' e or she may liaat�r•.} for back taxes and substantial financial penalties.
Owner :Wren / Date
y�� � CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
♦ � State Form 5473 (RS / 10-01)
���� Presrribed by the DeDartment of Local Govemment Finance
INSTRUCTIONS: See reverse side /or (ling instructions.
FORM
HC10
� � �
1 YE R
6 6 �'
'*'1
�
I(We) � V �`1, � c'(y thal the 1st day of M rch, 20
I(VJe) upied as our principal place of residence the following described real property for which a Homestead Pro y T�c C edit s h y dai d:
❑ I(We) owned ❑ Are buying under coniract
GI6SOt� COUN'.Y hUD1TOR
�Have a benefidal interest in the enGty that is liable for the pmperty taxes on the property and ihat owns the property or is buying under a wnUacl.
If buy'u�g om m�traq, Fee Simple owners name
Recoidefs atfice where conVacl is remrde0
County
If any
of Ihe
Tamship
3 L descriptio
swcture «the land na excee.Wing c
ice i�ome.
- a3 ii - i�o-
Tating district (dry, tawn, (ownship)
is ihe property in question:
❑ Real prop�
Rewrd number
❑ Mobile Homo
Page
immediatety surtountls that SWCWre is used tn produce income, desaibe Ne usa and portion
y
��� �, �'�-��.ii =- 4 �„
s F�?-�"��"';�ASSESSOR'US�E�ONLY'��'���� ��TRUETAX��- �ASBESSEDVALUE � HOMESTEADi�' Y '"t �7NON-RESIDEIJTIAL��p'��x
"-,,�. �- y 3i��*`3"5' ��v' VALUEY �� AT;100°/a OF'TNz �� �VALUE�� �w�'c-�j '�'VALUE�^ '-� ��
a..:.�,. ,?d.�.�aL,-`_sty.HdS,._d:L.S�'..°'1S.Ts.� �3.. . 3t-�.� _ t�..._ „z-�...a:_., ..F_''k++,......,f.'a.-::w 3�'�
Land not exceeding 1(one) aae immediatey (" ��� ��%`.�+�"'-�-��F'-� ��.�,Y�
surrounding residentlal improvements. ��',r�� �,�T ;.
e� .-`���' ,� h..�'x`
T.4L'�n3H' F
Other land ( � �`s�� ���� "
Z '�r -ta�s`aE::"':��
Total land (line 1 plus line 2) (3�
Dwelling (4) ��`"°`.ntq,�..��#��t�" ; =�s'�
Residential improvemenLs '-�'-���`�^`��+���5��
� s,�h t�-.�- Y c
Garage (5) �� �.; �'� �:�(
�y^s�.+''-���s'` ' �_,'
�,c aaa-::�-
Other improvements (6) -:�t = �'�
;,. x�'�af��,�
Tdal improvements (line 4 fhrough line 6) (��
TUaI value (line 3 pl�a line n (g�
I hereby certi(y ihe above is We, corred, and Signature of Assessor Date signed
complele.
Verifyi�g adan - Signature of Fwditor Date signed