Homestead_Brown (7)'�,g si�re o
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CLAIM FOR HOMESTEAD PROPERTY TAX �
CREDIT/STANDARD DEDUCTION
State Fartn 5473 (R2 / S92)
FORM
HC10
YEAR
• 16 �` INSTRUCTIONS: See reverse side �or filing instructions. ���
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CERTIFICATION STATEMENT
I(We) ^� certify th8t on the 1 st � of Mar , 1
I(We) occupied as our principal place of residence the following described real.property for which a Homestead perty Tax red i e � ed:
❑ I(We) owned ❑ Are buying under contract � rOVNTY AU01T�R
❑ Have a beneficial inierest in the emity that is liable for the property taues on the property and that owns the o�1�S�isbuying under a contract. .
- CONTRACT RECORDED
If buyinq on contract, Fee Simple ownets name
Recordefs office where contract is recorded Remrtl number Page
PROPERTY DESCRIPTIO
Counry r � — Township Ta�dng dis[ " t "ry, (nwn, towns � -
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P rcel mber Legal tlescnption
���o-'Oo33� -o 0
If any portion of the resitlential structure or the land noi exceeding one (1) acre that immediatey surrounds that siructure is usetl to protluce income, describe the use and portion of
ihe pmperty utilizetl to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
i Sgnature of tlaimant
ereby certify the above statements are true, correct and complete. • L
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Address (numbe� antl street, dry, sfa(e, ZIP mdeJ
e�.�'�a �9x a 6 0 �°�i.�-•�-�`e.�. �� �f 76 7 0
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately �� �
surrounding resideniial improvements.
Otherland (2)
Total land (line f plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify ihe above i5 true, cOrreCt, and Sgnature ot Assesor Da[e signed
compiete.
Verifying actlon - Signature oi Auditor Date signed
�� - STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
esser of 1/2 Homestead S
u tion or 52,00
Signature of Autlitor Date signed
2- %-o/
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Gibson CountyAuditor � � � � � � . � � � � �
101 N. Main SVeet � i„af.��d�is and mazried couples are limimd m one hamcstead standard dcduttioa As the rmeipt of this deduction becames
PnnCetOn, IN 47670 more brneficial, there is more incentive�ihan atr fochomcsiead (mud. Homestrad Gaud tauus higher tax bills (or all; themfore,
HEA 1344-20(19��rtquim taxpxyc�s who recei�c�ihc homcstcad standard deduc[ian to .�crify iha[ ihey are eligi6lc to rccci�c Ihe
� bencfit and to prm�idc addilioml identifiing infomntion necessary to allow counry grncmment to bena moniror homestcad
filing. lltis information will bc lept confidrn[ial and can onN be accessed by atnhoriad tounry officials. The Ucpartmrn: of
� F I L, E D I.ocal Grn�emmrn[ Fnance will �ue this information ro veate cools that will help munry off�cials elimirute homatead frzud
MAY 2 2011
— G'J. n�
— GIBSON COUNTY AUDITOR
1140
Michael K Brown .
2994 E Top Hat Rd
PRINCETON IN 47670-8859
'i���'�I"�I'llll��l'lll�'�'�'ll'I��II'�"I'��II�I����II�'I'I'I��
Taxoayer Name
Brown, Michael K/Tamare A
, o �
Lc�ation Address
2Q94 E TOP HAT RD
PRINCETON IN 47670
II��Ill�ulll �II�I III II I��IIII�I�II�II��II�II�II�III�III�II
' State Parcel Number� Leqal Descriation
26-12-15-200-000.330-027�PT W NE 15 210 2 AC P7
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This.form MUST be returned to County Auditor's of�ice.
Please do NOT send this form back with your tax payment to the county treasurer.
Addass (number and stree4 ciry, srate,
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codc)
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ID Numbcr (lazi 5 digis) � Oth (pledce spccify in Pan 4 below)
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undersigned certifies, cnder penalty of perjury, that the above and foregoing information is We and cortect a^.d thathe or she is eligible :o
✓e the homestead standud deducrion on this property. Each undersigned also understands that by claiming additional homestead�deducrions
✓fully, he or she may be liable for back [axes.and substandal financial penalties. �
� 1 gignapm i/ � , � pa�e Telephone
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