HomeMy WebLinkAboutHomestead_Brookman� ` CLAIM FOR HOMESTEAD FROPERTY TAX
CREDIT/STANDARD DEDUCTION
t State Fortn 5473 (R614-03)
' Prescribed by the Departmeni of Local Govamment FNance
� INSTRUCTIONS: See raverse side for (ling instructions.
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FORM
HC10
VEAR
i M'e) `/."1h1IO.CirY10i�( � d(�2e�.i!/ / r� 1.v�A6t, certity that on the tst day of,Merch. 20_
I(VJe) occupied as our prindpal place of residence the tollowing desuibed real property for which a Homestead Property T�c Credit is hereby daimed:
�I (We) owned ❑ Pre buying under conVact
� Have e beneficial interest in the entiry Nat is liable for the property taues on Ne property and that owns Ne property or is buying under a contract.
If Wyinp on wntrgq, Fea $imple ownefs name
Recwtlets oMCe where canVSd is tecwded
Counry
Parcel number
�Y� - �90=
If atry portion ol Na residential str
d Ne ProPertY utllized b produce
� � �����a��- /-io . 9�ai,vc� �_ �e �,
a the IarM rwt exceeding one (7 ) acre Nat immediatey surtounds Nat
ReCOrd
Pege
Reai property ❑ Moblle Home (I.C. 67.7-n
ire is used to produce incoma, destnbe the use and poNOn
"'z;��,'%���✓-.,:' r'3�-�?-:'2�-`�',...�'�",�.��'.=�xrPROPERTN��OWNED�BY.:CL'AIMANT,IN�OTHER��COUNTIES -.�'.?- � �'- ��'+��'`� -�-��'
. � .,,i, �. ,.,_... _ . ._, ..... ...
County Tavns�ip County Tonnship
I hereby certify the above statements ara We, cortect and complete. Signature ot Gaimant
iress (numbar aM sUeet, ciry, atata, ZIP cade)
� r��"� A ESS RO U E ONLY�'_ ���v x� F�' `+�TRUE TAX*'�' ASSESSEDiVAUJE HOMESTEAD �-`�r'- 'NON-RESIDENTIAL°� ,,,_� `
�;����"„t_ r,�s _ � "`��yk ��VALUE+4-Q�.�"'°}r !AT<100X'OF�,T�.V3 i»^,VALUEa� i-,�'•�t-.-"`�asi::VALUE �*,�,�� n.��-
k--_.. �'-"�:'�,.:.�,�fi7� ��%7?�C"-t
Land not exceeding 7(one) acre immediatey �'�;�+ ,� _%»��` � i�-�'�* = 3
r
surroundingresiden8alimprovamants. ��) ;�,,,.Y�����': G :yF�:� _``���,',.-'�
Other land �p� F i --fir; ��}s�-.,,�'�
X c .. •
i-t :- �'�.
TUaI land (I/ne f plus line 2) �g�
Dwelling (4) ��?' ��;r ��-�'% tn.,f`.�-+�yyK �c','
Residentialimprovemen4orMnualty �,,. ��-_ �..,;,�3� � ..,�_ s.;t
Assessed Mobile I ManufacNred Home 9 5 ;� y��%, k'.y�� Z�,� a� zr,
Gara e � � �„-q� ,, �
. <n:s< _�i'a�4?r:�s`T,.•�,.,t,.iX2� ^'
O�per improvements (6) } ,• S',�� �. � ?.
�.. ,. :.. < .
Tctal improvements (line 4 fhrougA liire 6) �7�
Tctal value (line 3 phs line � (g�
I hereby Certlfy NB ebove is W8, CofreCt, end � Signature of Asseswr Date sipned
compieta.
Verifyvig ecUOn - Signature of Auditor Data signed
�#�4.x-�`ku�.';5�.,��, ;�,`e'`,�,�` �.._�1�-�'` '*.*"�_:4;STANDARD!DEDUCTON'ALLOWANCE -� _ `�' ' "
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation or 535,000 S
SipnaWre otPyditor Date signed
. ......... ..._.... ...._._ .___.._ __.____ ______. .....__ .___.. ' . _ _
i�,
Gibson County Auditor
101 N Main
PRINCETON IN 47670
213
lliRfORY!!HIA:/vA1
iPfASUIIEPfOR4 :SIA
Individuals aud m�rrittl coupl�. arc IimiitJ lo orc hnme�eaJ �andaN Acducuon. As �hc rttcip� ot Ihis dNuaion bccomea
morc brneficfal, thzre is morc incenrnr than ner for homesxad (nud. Homo�eaJ fraud causes hi�her tax bills (or all: ihercfae.
HEA 13b1-?IX19 requim uxpa.rn .cho reccire ihe Iames�eaJ standard deduction w verity tM� iAey am elieiNe lo mcene �he
benefit am1 ro p�w'ide addiiional idemifi'ing iniomiaiiun Mcr.vrc �o allw� caunn� _memment m W.trcr monitor homrs�e:d
fili��.'fhis inlamuiion w�ill br Ae7u contiJemial and can nnly fu aceesv.vl by autharimd counry n�ci�ais.'Ihr Ikpannrcm o(
Local Gmcrtvncm Fw�rcc �vill uu Ihis intomw�ion N crca;r tu�ls �ha� �rill hdp cpmrv ofixial. eliminam homesmad frauJ.
, • , , , , .
Taxoa�•rr Name Prnpertr Address
Brookman,DavidM/Rebecca ���� N p��.+er<�g
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Prince�nn IN;7670 ^�
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David M Brookman
1742 N Old Petersburg Rd
PRINCETON IN 47670-8509 Stare Parcel Number
���n��n��i��u��i�����n�n�n�i����ui�i�����n�n�i��n�i� 26-0531-400-p00.090-027
_. - _ _ _ _. - _ - _ . _ ._ ___ —.,_- ✓
Leyal Descrintion
OOfrOW90-00 PT S 31 7 70 .9721 AC
C-1
This form MUST be retumed to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
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Address (number m�d so-ece, city, smro, and ZIP code)
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undersigned certifies, under penalry of perjury�, that the above and foregoing infortnation is true and coirect and that he or she is elieible to
:e the homes�ead standard deduction on �his property. Each undersiened al;o undemands that, by claiming additional homestead deductions
rfully, he or she may be liable for back taxes and substantial financial penalties.
I SiennNre Ux�.