Homestead_Christy (3)E Si�)E
`� �°, CLAIM FOR HOMESTEAD PROPERTY TAX
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CREDIT/STANDARD DEDUCTION
�J� State Form 5473 (R2 / S92)
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INSTRUCTIONS: See �everse side for liling instructions.
FORM
HC10
YEAR
FICATION S ATEMENT
(I(We) certify Ih��t�' y of��
I occupied as our ri ipal place of residence the following described real pro e for which a Homestead Prope arz � is e
I(VJe) owned Are buying under contract
❑ Have a beneficial interest in the entity that is liable for [he property taxes on the p perty and ihat owns the property ���uuy��n�onVact.
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CONTRACTRECORDED �/ `�
It buying on conVact, Fee Simple owners name �:,'1!..'%.'
GIBSOii ci;;';;;;TY AUDITOR I
Recordefs office where conVac� is recorded Record number Page _
PROPERTY DESCRIPTION
Counry Township � Ta�dng disirid (ciry, o, f sh"
ber �� ' � Legaldescnption
tl any poNOn of the resitlential struc[ure or ihe land not ezceetling one (1) acre that immediatety surtounds ihat structure is used to produce income, descnbe the use and portion of
the property utilized to produce income. �
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Counry Township - Counry Township
S nature ot claimant
'-eby certity the above statements are true, correct and complete.
ddress (numbeianAStmeL ciry, state, ZIP oode) �
�F o^� \CYi� NaAT �O F�\vcx..�'�l � �i�1 y�l�o1D
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
� Land not ezceeding 7(oneJ acre immediatety (� �
surtounding residentiai improvements.
Otherland (2)
Total land (line 7 plusline 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Oiher improvemenis (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signawre of Assesor Date signetl
complete.
Ventying action - Signature of Auditor Date signed
• STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
- Lesser of 1/2 Homestead S
Valuation or 52.000
Signamre of Audimr Date signed
•
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IR:AS�AkAlU0.YISIA
II IL\1411f b:.l-L�l
GibsonCountyAuditor � � � � � � � . � � � � � �
101 N. Main Sireet �ndicidualo and irtu�ittl couplr.. aie Iimi�cJ m onr hona9caJ >LUiSvA Jeduclion. i\e ihe rtteip� o( thi> dnluciiun bccoma
Princeton, IN 47670 morc bcceficul, Ihrc is morc incrn�i�c Ilun cccr fnr honr.>imd Gaud. Homot;ad (rauJ ca��cs Sfchcr mc bill. Inr.IC �h Kc�am,
� I1E:\ IiJ4?W9 rcyvirt5 [azO�J'en w'�u r�e:ire ;he homr>tmd uanJard deductian m�erify tFac thec are eligihle m rmrivr �Ac
�'n �_ io prrn�idc miii�iunai idcmitying ir.fnmu�tlon m:csvn� m alkm� mumr ¢m'cmmcm ;o tYKicr mniior homcan.d
iLr. ❑ informa�im �.iil br A�p emfiJuniel md can nnk br xm>.ed b.� amhwizeJ roumy ollicul.. TM Depanmer,t o(
�c� C:rr.�xm i�inancc .� ill u.c Ihi. in(ormauon m crcnr �rol� :hm x911 M1dn counrc o(ficiaL. climimtc Mmcacad Inud.
— '1 1' /
MAY 11 ZOIP 7axnaverName LocationAddress
C� N� Chrisry. Kreig R/ Pamela D
3031 E TOP HAT RD
GIBSON COUNTY AUDITOR PRwCE70N w 47670
3503
Kreig R I Pamela D Christy
3031 E Top Hat Rd
Princeton IN 47670-8860
ull I ulllulullWllu�Il��I�IIII�I�I�IIWIIWIIW Ilullulul0ll II
III��I�II��'��I����I'll���'�I��'��'I��I��'��I�"'ll����l�ll'�I"� State Parcel Number Leaal Descriation
26-12-15-200-003.666-027 PT NW NE 75 2 10 .77 AC C-1
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
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K�e�� I
y Addrzs ninnbcr a� stree4 riry�. sia:c, anJ ZIP codc)
;i.�.rao �IAT kd. �P����Q+oti
$ecuriq� Number Qut 5 Jigilc) Drivers I.i<ense/:
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RO�e r �C
�r� `f ) b� J
y� I �ar �<ne
T etehQ I �.
Aailing Add�zss (�ember md smt, ciry�, stat_, and %IP code)
3031 � i P}�Ar Rd. �r;h«d���; �^� 71b1�
locial StturiA' NmriUer Qut i digia) Drivds LicenulStnm ID Numher (Ias.S digi:s)
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C��;sdy
Same as propcm• add:ess
(plrase ep;cify ir, Part 4 below)
Su�e
�h�cS�.l
I�-3mne as property add:c�s
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ir. Pan 4 Mlow)
undersiened certi6es. under penalry of perjury, that the above and foregoine inCormetion is true�and correct and that he or she is eligible to
: c the home<_tead standard deduction on this properry•. Fach undersienecl also underslands that, by clximine xdditional homestt�d deductions
� fully, he or she may be liable for back �es and substaniial financial penalties.
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