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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side /or filing instructions.
FORM
HC10
YEAR
CERTIFICA ON S TEMENT .
1..... ,
I(We) � certify ttiat on the 1st day�orf� �M�arch, 19_
I(We) occupied s our principal place of residence th ollowing described real property for which a o estead Propert� C�c�F igpe[¢ny claimed:
❑ I(We) owned ❑ Are buying under coniract •
❑ Have a beneficial interest in the entity that is liable for the property ta�ces on the property and that owns the p erty or is bu mg er a c- tra
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� � CONTRACTRECORDED '" ' v
If buying om m�tracl, Fee Simple ownefs name
Fecordefs oKce where contract is recortled � Record number Page
� PROPERTY DESCRIPTION
Counry � , Township Taning tlistrict (dry, mwn, rownsAip)
Parcel numbe= Leqal tlescription �D �
C
If any pomon of ihe residential structure or the Wnd not exceedirg one 7) acre thai immediatery surtounds ihat swc[ure is used to produce income, tlescri ihe use and �on of
the pmperty ulilized to produce income.
PROPERTY OWNED 8Y CLAIMANT IN OTHER COUNTRIES
Counry Tovmship Counry Township
Si f clai an
.iereby certify the above statements are true, correct and complete.
A r number and st ef, dry, slate, ZIP cod ^
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ASSESSOR USE ONLY _ TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VAIUE VALUE VALUE
Land not exceeding 7(one) acre immediately (�)
sunounding residential improvements.
Otherland . (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residen�ial improvements
Garage (5)
Other improvements (6)
Totai improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7J (8)
I hereby certify the above is true, correct, and Signature a Pssewr Date signed
complete.
Veritying action - Sgnature of Autliror Date signeA
�� STANDARD DEDUCTION ALLOWANCE
79_ Pay 19
Lesser of 1/2 Homestead S
Valuation or 52,000
SignaNre ot Auditor \ � Date signeA
l.�l 3 - Oc�
� Gibson County Auditor
101 N Main
PRINCETON IN 47670
C J
1410
Kevin R/ lizabeth A Besing
4137 W plit Rail Lane
Princeto IN 47670-8444
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InJividuaL. anJ ma;riN couplc arc limitcd m nre homeacad 9andaN JcYluction. As �he recripi ot ihis dcducCan beconm±
nwrc beneficial. therc i. morc incentire dun e�er (ar homesrcaJ fnud Ilomesrc:rl frnwl causr, higlxr ta� bills (or all; thercfae.
HEA Ii�tA-?O(19 requilcs uxpa�en Mho rmtirc Ihe hnnesa-aJ standard JNuction to verilv tlu� �he�� art cGciWc to mtti�c Ihc
benefit aml to prtr�iJ<:WAilio�ul idenuirin_ infurmatwn necr.vey to allux' counrc gwrmmeni ro bU¢r muni�or homrsrc:rJ
lili�,�. lhis in(mmalion will M Aryv mnficuuial and �n nnly h arre. �nl b� awhnrized rmmq' nOkivl�- �f6e Ik�anmem of
Lucal Gw'cmmem Pinmwe ��ill uw this intormaeion tu crcam �wls that a'i0 h:lp c�wnty uffuiaLs diminarc Iromcsmad fraud.
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Tazoaver Name Prnpertc Address
Besing, Kevin R! Elizabeth A
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Owncr 1 First �
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� ig AdAmss �num'DCr end iacct: cirv. sca�e. enti ZIP cuticl– ---' -'
� �-I� I �-7 In� �� � I '� �rn ; ,
Seeuriry Number (last 5
ID Nmnbcr pui 5
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Nailinc Addrtss (Number md slrce4 cin', slal<, and "LIP cpk)
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iocial Stturin� Numbcr (last 5 digi�s) DrivcYS Liccnscl5ta�c ID Numbcr (laq 5 dig�.
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State Parcel Number
26-11-09-300-OQ3.919-027
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R3 13ox 31? Aa
1'rinccmn I\ 47670
- Leeal Description
006-03919-00 M C ROBERTS OLD
OWENSVILLE RD LOT 8 D-77
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c; p�µ.—,, W'w�., — _
Pan 4 bclox�)
t�x �► � �
�Sme :u p(openy addra>
in Part � bclow)
undersigned cenifies, under penalty of perjury, that the abovz and foregoing information is trve and co�rzct and that he or she is elieible to
re the homeslead siandard deduclion on this property. Each undersiened also understands that, by claiming addilional homestead deductions
ifully, he o,-she may 6e liable for back ta.ees and substantial financial penalties.
1 SiEnaWrc Uatc Tclephonc ��