HomeMy WebLinkAboutHomestead_DeputyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION ,
Stata Fomi 5473 (R614-03)
Presaibed by Ne Department o( Local Govemment Finance
INSTRUCTIONS: See 2verse side lor filing ins6uUrons.
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FORM f�� YEAR
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� �e) ��"I— ' certiry tha�,bryU�s,15w� March, 20
,I_,(_W/e) occupied as our principal place oi residence fhe (ollowing d scribed r property for which a Homeste d Plqp�Erty i daimed:
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LJ I(1Ne) owned ❑ Are buying under conlract �IBSUN `��� �/���
� Have a benefidal interest in the entity ihat is liable for the property taxes on lhe property and Ihat owns the property or is buying under a contract.
I( buying om m�uaG. Fee Simple ownefs name
Recordels olfice whare mntraq is recorded
�.��.�I,�p"ret.:�Yj,� y A:i.i1='i:;i.�"iL:."'1'
'.F'���. ;f.F�"�rru� ��:^E's: �' :�'Y
Cwnry � 7armship
Record number � Page
Par/�cel num6er C O,Z'] L/pJy al descriptionC Is the proyerty i question:
2`� - � � - lJ' � d �-���•�� � r r _F N (� �� � �Q � A � �Real property ❑ Mobila Homo (1 C. 61 7-7)
If any porhon of Ihe res+dential sW cWre w the Wnd not exceetling one (1 j aae IAat immediatety wrrounds that Gure is used tn protluce income. describe Na use and portion
of the properry u�lized lo produca income.
County
County
I hereby cerlify the above statements are We, covect and complete.
(number and stree(, cdy, state, ZlPCOde)
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.�s�'�. �,�ati-..�v �,3� � �,.• K-, j'�w�+?� i 7.c n . ,. � x s.�.. � �: 't �+ . � s�
�� � spSSES50RDSEONLY "'z L�.g'� , TRUETAX�, �� ASSESSEDVACUE 2�HOMESTEAD _ � NON-RESIDENTIAL�' � i
� • + € � e °4"' VALUE a� �i.��i...`�t�}�r:w �,•VALUE"' -'' .
s��e. �:=^_Ta;t" _rt��"s� .r���?la�j�wVALUE: AT100/aOFTTV � y, � ('c��
M. Y.♦ Ci tF-+kS..• n� i��.Y� ...� �Y`-E^
. . �. .._ -. .. ..« ... .�.o—�r...a. —�, -
Land not exceeding 1(one) acre immediatety F����}�{��,�.�.-�y�,y���',,,,,}�
surrounding residential improvements. (�� a3-�- ,� �S.��y°E§.p'�� y����%,k�;
Other land (p) �` ��'- ,�`e.�n� �
•.V ��.��_���.�
Total land (line 1 plus line 2) �3)
� ,� -r �wx - � �� -c�
Dwelling (4) j �� ���,�y.-���������
Residendal improvemenLS or Mnually 'F��
Assessed Mobiia / ManufaUUrad Home Garage (5) ��t� �' ...s.- � �"^ � �
� '�,���a�-'. �.�.. �-;.r ��`�'�
^�� � k
Otherimprovements (g) c ������
TUaI improvements (line 4 through line 6) (�)
Tctal value (line 3 plus line n (g�
I hereby ceAify the above is We, coneU, and Sgnamre otnssessor oate signed
complete.
Verifyiig action - Signature otlwditor Date signed
� .,» : -+ _ _^ � . �..
�'s-'yr�.��'�-���`. -E%l��.`=��a'`�.s-'.�,i`��'��:s:STANDAR�'DEDUCTION'ALLOVIIANCE ��,,,,fe�},+�;�,i-,�i�O„���."�_�_3?�",��','�_�� �
20_Pay20_
Le;ser of v2 Homestead
vauauon or 535.000 5
Sgnaturaoftwditw � Da�esigned
Gibson County Auditor
101 N Main
PRINCETON IN 47670
1319
tii(E NRM!)Klll'15.x1
A�iRIT'ED BY [l1TE MiRDllf MYY11�\Tl 1�.0
nr.�suvxroa�n�n �
InJiridua6 and insrriN couple are IimitN to orc hnmeueaJ Aandanl d:tlu.uon. As the �eceipi ol' Ihis JNuaion Mcomea
mure beneficial, therc is morc incenei�r dun e�er (or homesrcsl Gaud. Ilomn'reaei :aud causes hi�her q� bills lor all; thercfore.
HEA 13-4i-?(N19 requim mapay<n x�ho reccivc Ihc hanesicad smndard d3luction to veri(y �hat they art cligiNe lo mcei�e Ihc
benefi� and to pnn'ide mWiuonai iJemifyinc infomiatiun nemsary ro ailw� cwnp� grn'emment tu betrcr monitor homesttaJ
filin�. This inlnrma�ion will M Arry ennli�iemial and oan only M: aace:�eJ 6v aWlrorizeJ couNy oRcial+.lTe Ikpanmem nf
Local Gmcrmncm Fivnm will uw this in(umia�iun tu i�ream twis that will h:ip cwnn� officiaL. elimiwrc hum<s�ead traud.
�� �. �
T•rxnaverName Proper���Addretis
Deputy. Matlhew W `
R? F3or?69 A
cemn 1\ .i7670
Matthew Deputy
3297 E 50 S
PRINCETON IN 47670-8871
�i�n��u��i��n�ni���ni�n�i�n���n���n���i�n�ni�i��u�
State Parcel Number
26-12-15-200-000295-027
— _ ✓ — —
Leeal Descriotion
OOFr00295-00 PT E NE 15 2 10 1 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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Owna I First Afiddl< Lac�
H� �A �F ��
-@ Address (mimber nnd so-m, ciry, seate, and ZIP code) �6�ne ns pm . oddrcss
9% � J"�� J� /'..�1r✓!'r9d�/ ,�l �i?(oiQ
$ocial5ecurih' Numbcr (last 5 diei6) Uriva's Licenae/Sta¢ ID Number (lazi 5 di¢iL) Other (ple:tse speci(y in Pan 4 below)
�
Spousc First Middic Last
Mailing Address (NUmber and slree4 cily, slaie, and ZIP cak) �$ame u pmpem addrer
Social Securiry Number (laa 5 digia) Drivers LimnsNSta�e ID Niunber (la,� 5 digits) Other (plcase specify in Part 4 bebw�) �
Svx
_ _ _ _ ' __
Each undersi�med certifies, under penalty of perjury•, that the aboae and (oregoing information is we and correct and that he or she is elieible to
receive the homes�ead standard deduction on this propeny. Fach undersigned al;o understands that, by claimin¢ additional homestead deductions
unlawfully, he or she may be liable for back taxes and substanrial financial penalties.
Oo�Mr I Si6maWrc Untc 7'cicphmc
/'/� G� S o2 �?d/O � .
Spou;e Simafurc py�� Tcicphonc
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