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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sta[e Form 5473 (R2 / S92)
INSTRUCTIONS: See reverse side forliling instructions.
FORM — YEAR
HC10
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� CERTIFICATION STATEMENT � U L
I(We) e n he st a� of Mar 1
I(VJe) cecupie as our principal place o residence the following described real property for w�8 Hotn stea. ;Pro T�jg�is.he ' ed:
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❑ I(We) owned ❑ Are buying under coniract -' �: ,+-��
❑ Have a benefitial interest in the entity that is liable for the property taxes on the property and that owns t e property or is buying under a coniract.
- CONTRACTRECORDED -
If buying on convact, Fee Simple ovmers name �
Recorder's office where conVact is recortled Recortl numDer Page
PROPERTY DESCRIPTION
Counry Township Ta<ing district (ciry, fown, townshipJ
P Ipy r � �— ^_ Legaldescnption .
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If any portion ot Ihe residemial stmcture octhe land not exceeding one (1) acre Ihai immediatety sunounds t s cture is used to produce income, deuribe Ne use and portion of
Ne property utilrzed to P�duce income.
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES �
Counry Township Counry Tmmship �
Si naNre a'una
areby certify the above statements are true, correct and complete.
Atld ss (numbe� anLd,iheeG ciry, state, ZIP oode)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (� �
sunounding residential improvements.
Oiherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Otherimprovements (6) .
Total improvements (line 4 through line 6J (7)
7otal value (line 3 plus line 7) (8)
I hereby certify Ihe above is We, correct, and Signawre of Assemr Date signed
complete. .
Veritying ac6on - Signamre of Autlitor Date signetl
STANDARD DEDUCTION ALLOWANCE
79_ Pay 19 _
Lesser of 1/2 Homestead �
Valuation or 52,000
SignaNre of Auditor Date si netl
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
1818
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Indiciduals anJ irt�:rieJ mupla arc limimd �o one homcuesd uanJaN dNu.iion. As �he rcceip� o( Utis JeJuction l+ecomea
more beneficial, ther< is more incrntire than e�er (or homeo'tead Gaml. Iloma�eaJ RauJ caases higher ta� bilL fw:Jl; thercforr.
HEA 1337-3(N19 requirts uspaym v:ho rcccire Ihe hanes�rad s�anda�J deJuction to .crity that the. are eli;iNe to recei.e thc
Mnefi an1 tu prucide afAi�iu�ul identiiyinv� infwmatwn necr.vn� �o allw' cewmy gwemmrnl m Wetar mmitw homrsreaJ
tilin��_ This inlarmmion will M1t Am1 mniideniial and ean nnl� h• aeeec<N In' autM�iv[J counry' niTcials. The IXpnnmrnl of
Iw¢al Gm'ermnent Fimnee ��ill u�e Ihis iniurtnation m crea:c [vls �ha� �eiil h:lp eu�mtt offirials diminam homcsteaJ tiaud.
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Tnsoacer Name Prooertc Address
Blackburn, Richard A & Nancy
Whyms
RI 6ox i5
1'rince�an IN;7670
Richard A Blackburn
2302 W Columbia Estates
PrincetonlN 47670-9318
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Addrtss (number nnd svmL city, sute, and ZIY code) — -- "--
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ecurin' Numbcr (lan 5 digiu) fhivers License/Sute IU Number (lazl 5 d
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State Parcel NumAer
26-11-14-102-001.887-027
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Leeal Description
COLUMBIA EST 22
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�s Pm�Cm' aidress' -- __. _. '
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�ilin� Address (Number and nrcc4 city, sia�e, xnd "LIP caie)
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cial Security Numbtt (latt 5 dieits) Drivcrs Liccnu/S�acc ID Numbct (lazt 5 digi[s) Ott
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D��sc spccify in Pazt: bclow)
undersiened certifies, under penalty of perjury, that the abovr and foregoing infortnation is we and coirect and that he or she is elieible to
�e the homestead standard deduclion on this properly. Each undersiened also understands that, by claiming additional homestead deductions
�fully, he or she may be liable for back tares and substantial financial penalties.
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