HomeMy WebLinkAboutHomestead_Burkett (5)°� CLAIM FOR HOMESTEAD PROPERTY TAX �o�M� R
- CREDIT/STANDARD DEDUCTION H o
` State Fortn 5473 (RB / 7-07)
` Prescribed by the DeparUrieM d lo�l Govemment Finarxe
INSTRUCTIONS: See reverse side /or filr� ins6uttions.
MAY G 9 2008
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I I(We) � i+ c�..�� � Y i� ... ... • °� � p o IRC(11J(�(�UN7V A D�TOR
certify ihat�rTtF�81"sC�ay of Ma�, 20_
I(We) oaupied as aur prindpal place of residence tlie following described real property fw which a Homestead Property Tac Credit is hereby daimed:
�I (We) owned ❑ Are buying under contraG
.� Have a benefidal interest in Ne entiry that is IiaWe fa the property taues on the property and ihat owns the property or is buying under a contrad.
It buyinq om m�Vaq, Fae Simple wmera rume
Recartlefs o15ce where wftrad is recaded
Counry TovnsNp
Parcel number Legal descriplion Is Ue prq
��- l 1- I(� - ti�- l V,1-t�1
tt arry ponion of Ure residemial swcwre or the IaM not excaedirg orre (7 ) acre ihat immediately wrtnunds ihat
of Ihe pmperty uliGzetl lo produce inwme.
Recortl number � Page
fownshiP)
in quesUan:
�al pmperty ❑ Mobile Fbme (/C 6-7.7-n
ture is used to produce'uxome, descnbe Ihe use eM portbn
•- �
� � . � • �
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Land nol ez�ng 1 (one) acre immediatety , � . � � - :
surtoundirg residential improvements. (�� . .
Other IarW (2� �,_ . .
S ^r,
Tdal land (I'me 1 plus I"me 2) (g)
. s
Dwellirg (4) � .
Residential improvements or Mnualty " '
Assessed Mobile I Manufac4ired Home - � _ . . . . - -- •
Ga2ge �5� _ '
_ �.
Other improvements (6) %1,:�-..f ''-'-.�;��•':•�;.;:
. �>:N> v
Tdal improvertrents (I'me 4 through line 6) ���
Tc1al value (line 3 phs Gne � �g�
I hCBby CefGfy Ne abwe is hue, ColfeU, and Sigriawre ofAssessor Date signed (mon1A, tlay, yea�
complete.
Veiryirg action - SipnaWre of P�tlita Date signed ( N, day ea�
�.-� � � • •
20 pay 20 _ qs.ppp for 2007 pay 2008 42.000 for 2010 pay 2011
Lesser of 12 qq,000 for 2008 pay 2009 47,000 for 2011 pay 2012
Homestead Valuation S
« 43,000 for 2009 pay 2010 40,000 payable aRer 2012
SignaWre of �Iw Date signed (monN^, Oa ea�
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Gibson County Auditor
101 N Main
PRINCETON IN 47670
fl�tElOR.\I�!W IRJ�WI
`��`� IAF:TA1�mUTitlC
YI.�
IndrviduaL+ and �rt�r�icJ coupks arc limiltd �o ore homr�caJ uaiMaN JeJunion. .4s the rmtip� ot ihu dedurtion bttomo
murc beneSciaL rMe ie morc ineenmr tlnn r�er (or homesrcsl traud. IlomnrcaJ fimal ou�es hi�her ta� bills tor all; the�efcre.
HEA 13ii-?G09 requirn uipa�en w�ho rtcci.�c ihe hanesteaJ siandard �vfunion m verify �lu� �h<y art cliciWe �o mcci.c �Ac
benefii an1 tu pn»'iJe :MM1iGOnal idennipirc: in(wmatiun Mcr.vn� �o allw' oounry ga'cmmrnt to bener munitm Iromestr.d
lilin��. -Ihis iNnrmaiinn will he Ary4 mnliJrnlial and ran nnly h. eccesseJ Fy aulMrizd rnuny' olliti�al�.'1'M1r Ikpanmcnt of
lucal Gov<mmem Fim�rce will u.e thi� intormation m cream twls tlut will hcln m�nn� officiala diminam Fx�meamd 1}auJ.
Taxpa��er Yame
Burns, Dennis R/Karen
1917
Dennis R Bums
1195 S Hoot Owl Lane
PRINCETON IN 47670.8147
�i�i���n��i��i��������ii��i���in����n��in����in�i�in�i��
i 1 F'irstl
.�E1JN1 S �
ig Addrtst (numbePund��itrctt, city, s[etc, and ZIP codej---- -' —'
l l-r(5 5. 1—I00 i C�c�L Llf
.ilin� Addres5 (�umber and sVtt4 ci�}', staie, and ZII' code)
llq5 S l�ooT 0�� l..r�
:ial Saurity Numbcr Qaz� 5 digiu) rivds LiccnsGSWic ID Numbcr (la;t 5 digits)
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State Parcel Number
26-11-16-400-000.147-027
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Prooert�� Addreas
Ftr � t3ox ?OR
Princeton IN 47670
Lesal Descrintion
PLEASANT HILL 25 D-17
t-v� �S
Samc a; prepem• oCdr¢s —
Oih<r (plcnse specify in Pan 4 bclow)
�Same a propeny addros
Othcr (plcasc spccify in Pan 4 bclow)
undersi�med certifits, under penalty of perjury•, that the above and foregoing informatiun is tme and correct and that he or she is elieible to
�e the homestead standard deduction on this property. Each undersiened al>o underslands that, by claiming additional homestead deductions
�fvlly, he or she may be liable (or back taxes and subsiantial financial penahies.
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Si�maturc Uaic
�h��X. ��4�n,y �1-22- /0
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