Homestead_Defelice1� s*up `
i �` CREDIT/STA DARDTD DUCT ON RTY TAX
;• �il• State Fortn 5473 (R2 / S92)
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INSTRUCTIONS: See reverse srde /or filing instructions. �
STATEMENT
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� FORM
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YEAR
'e) .CJ �, �,TD ��Al_m R� L�9-6i�}d U, certify that on the 1 st day of March, 19_
'e) occupied as ou rincipal place of re�idence the following described real property for whic omestead PropeRy Tax Credit is hereby ciaimed:
I�We) owned ❑ Are buying under contract •
Have a beneficial interest in the entiry that is liable for the property taYes on the property and that owns the property or is buying under a wntract.
It buying on contracc, Fee
Recordefs offxe vrhere a
Counry
Parcel number
�b�'Op
If any portion of Ihe re:
Ne praperry utilized to
name
� - wi
structure or the land not
income.
CONTHACT RECORDED
PROPERTY DESCRIPTION
one (t) acre
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
I hereby certify the above statements are true, correct and complete.
�dress[f!y�y m�yr �an�d sireet, ciry, slate. ZIP��o)d_ e)
i 1��'rl � 7C �' ri N'u.iO�s'1 �%'� �'! i'1
ASSESSOR USE ONLV TRUE TAX
VALUE
Land no� exceeding 1(one) acre immediately (� �
surtounding residential improvemenis.
Oiher land (2)
Total land (line 1 plus line 2) (3)
Dwelling
Residential improvements
Garage
Other improvements
Total improvemenis (line 4 through line 6)
Total value (line 3 plus line 7)
I hereby certify the above is true, correct, and
complete.
Venfying action - Signature of Auditor
19_ Pay 19 _
Lesser of 1/2 Homestead
Valuation or 52,000
(4)
(5)
(6)
1�)
le)
��1•�n�- e f}
ASSESSED I HOMESTEAD
VAWE VALUE
STANDARD DEDUCTON ALLOWANCE
S
use
NON-RESIDENTIAL
VALUE
signed
signed
S
., • :.
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Gibson County Auditor
107 N. Mafn Street
Princeton, IN 47670
FILED
NOV 19 2012
— G`J,nb�y
v�
�g�ON COUNTY AUDITOR
Richard A/ Kelly J Defelice
91 E 150 S
Princeton IN 47670
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.VPR(1�'EI1I11':i\iE IM�\RCOf.YI lV \iT. \�M
rw..tuwnni'nu.
1R:TSp0.lAlM1.N RIA
InJiriJualo and mvrinl couples arc limi�c.l to one hnnksieaJ scrtuLrd dnluctioa A> thr recef{u of :hf> Jnluaim� 6numes
morc Mnencul, ih�r. is mprc ir.crn�i�c �han �cr (or hmnc.�ad fmud. Humc�tcad @auJ cauas iichcr m� bill: lor a1C th Trtar_.
H6\ IiJi-_'(N1V reVUir:s uapa.en uho rm;ire :he homc��ead ..tandarJ deduc�iun �o eerify tEa� Jxq arc eligihle ro ncti�e �M1c
Rncfi� anJ w pr.niJc xkiiiional idcntikin� imiumauon nc:amrc �o al4.w mnmr em'cmmcm �n Caur n��nnor homca�d
filir.c. �Ihi� infnrmatim xill be Acyl eonfdmttul �nd c:m nnk M:nYC.�rd bc authuriu�l mumy o(licial.. The Deponmam o(
Local G�r:crrr,xm Rnanec ���ill u.e �hi. infomiation io cnarc umh ;M1ai ��ill hcln eounrc ofheuL, climimtc MmorcaA frauJ.
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TaxpaverName LocationAddress
Defelice, Richard A/ Kelly J
94 E 750 S
PRINCETON IN 47670
IIII�I�III��III�II�I Illull I��II�II�IIII��II�II�II�III�I�II�IIII� II II�I�I�II II
State Parcel Number Leqal Description
26-12-18-403-000.445027 PT SE 18 210 1 AC
This form MUST be returned to County Auditor's office.
ease do NOT send this form back with your tax payment to the county treasurer.
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(� iG�'l�l'G� �`�'�10 n
: Add�es� (numbcr and slrtet, ciI}', ata:e, and "LIP codt�
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Addrtss (\embv md s•.mt city, state. and 7.IP rnlc)
I/ I A/
��F� �ice
I= 1�$ame as prope�ty adc:ess
LJ
Olha(please
undersiened certifies, uader penalty of perjury, that the above and foregoing inform¢tion is true and correct and �hat he or she is eligible to
re the homestead�standard deduction on this property. Each undersiened also understands lhat, by claimine additional homestead deductions
;(ully, he or she may be liable for bacA taxes and substantial financial penalties.
� 1 SignaNre Date Telephoae
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