Homestead_Cornoyere��� � CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
a CREDiT/STANDARD DEDUCTION HCiO
� State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side /or (iling instructions.
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I(We) � cenify that e st a 7_
I(We) occ pied as our principal lace of residence the follo i g described real property tor h a Homestead Propert�Tau CrediCS hOOOY Gain
� I(We) owned ❑ Are buying under contract ��`� �
�� Have a beneticial interest in the entiry ihat is liable for the property taxes on the property and ihat owns Ihe pr, rty or is buyjng yfjiier a co�tr,
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- .,. - - d < ;,_ �i— ' :•' -. � CONTRACT RECORDED r." ... , �.: °' �'s,�: r . �:: '. .•.,
.r,',.: - _'3� . e F..Y:r
If buying on coniren, Fee Simple owner's name
�ecorder's oHice where contract is recorded Record number Page
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County Township
Par Legal deunption
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If any portion of the resitlential struclure or the land nol exceed
of the pmperty utilized m produce incame.
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-"� PROPEH'TY DESCRIPTION �- ,; - .��,°,� �,,
Ta<ing tlisinq (city. rown, township)
��r�all-1_ /o . 3� +�c.
one (1) acre that immediatety surrounds that swcture is used [o produce income, tlescribe the use and portion
° ` � PROBERTY OWNED�BY-0LAIMAM:IN OTHER COUNT7ES : � � � � �
County Township Counry TownShip
I hereby certify ihe above statemenis are true, correci and complete. Si re c �
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4es5 (nu r and sfreet, city, sta( ZIP code)
'� ' �"' T - � �' . TRUE7AX - � .ASSESSED� � HOMESTEAD� NON-RESIDENTIAL"��
�.,�y� '� �..-ASSESSORUSEONLY `, � `; � VALUE' � -�VALUE •sVALUE., � ..-:-�--,VALUE•���'� . . ��.
Land not exceeding t(one) acre immediately - -���.
surrounding residential improvements. (�) - �'�`-"
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Other land �] tH ` �F
�L� :n3�0�� 0. I'�5
�._ �'.Mi: i.g'..t^S_�'i._ .'
Total land (line 7 plus line Z� (3� �
Dwelling (4) ' -
Residential improvements .. .
Garage (5) . . �� . -
Other improvemenis (6) � . � -
Total improvemenis (line 4 Ihrough line � (7)
Total value (line 3 p�s line � (g) I
I hereby certify the above is true, correCt, and Signature of Assessor Date signed
complete.
Venlyirg action - Signamre of Auditor Date signed
19_Pay79_
Lesser of 1/2 Homes[ead
Valuation or $2,000
SignaWre
�
Date signed
t�-as-o�
STATE Po0.N 53569 (RlB IO) TRC: �SURER FORA1 TS-IA
APP0.0\'FD BY SfATE BOAAD OF ACCOII�TS, 2009 PItESCRIBED BY' T}fE DEPART¢�T OF LOCAL CAVER.\'ME\T iI�A\CE IC61.1-'_'-8.1
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
rleduction becomes more benefcial, there is more incentive than ever for homestead fraud. Homestead fraud
�auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who recei��e the homestead
standard deduction to verify that they� are eligible to recei��e the benefit and to provide additional identify�ing
information necessary to allo«� county go��ernment to better monitor homestead filings. This information
will be kept confidential and can ouly be accessed by authorized county� officials. The Department of Local
Go��erument Finance will use this information to create tools that �r-ill help counh� officials eliminate
homestead fraud.
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Taaoa��er\'ame Pronem�Addrcss StatePamel\umber ' LeealDescriotion:
Robert B IV Mary� Lou Comq�cr II Z�a W ZZ� N 26-OSAO-21 I-OOOA46-027 PT LOC 211 I 10 37 AC
PRMCETON RJ 47670 C_ � _,/
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Completeandreturnro: I�IIOp1l�ptfu��I�p��u�'Ip��� I�I�II1'���II�
JWILL �
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
1 �
OwT¢r1 Fvsl MiEtl18 L85f
� n�i°Yi BruLe e," �L �ruce Ca�noyer Zr
Mailing AECress (rnmCer arq cVaet ury, s entl ZIP mCe)
�n� � ��� � Qrl �e�n, �� ��� �� � I Same es yoperty eECress
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Sorial Seaviry NumCer Qast 5 dlplb) Omafs licanso/5tate ID NumOer Qast 5 Eiglts) sms Otnx (please specity in Part a belo-x)
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Spa158 F✓Sl MWEIB /� L85�
(}� � Du (� Orn oy2✓
MaSVg Adtlreu (nmEer arW sueet, ti7. sta;e antl ZIP mCe)
Same as oroperty atlaress
��4 W��,5 N Pr� ncefa�, ZN �{7�7v
Social Sewnry NumEer (Iast 5 Elglu) o�rs ��,ws�ia io rh,�„ea. p+:� s aie��al �e �Ner (Wease soarAy in Pan a tebw)
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� Each undersigned certifies, under penalty of perjury, that the above and foregoing information is true and wrrect and that he or she is eligible to receive the
homestead standard deduction on this property. Each undersigned also understands that, by claiming additional homestead deductions unlawFUlly, he or
she may be liable for back taxes and substantial financial penalties.
Owner 1 Siryunae Da:e Talaptme
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� N 2013