HomeMy WebLinkAboutHomestead_DicusSTATE FOMIS� 569 (W18.10) I 77��SUIIER FONDI TS-IA
APqRO�'FD BY SiATE BOARD Q°+�CCOU.YfS, 3009 PRFSCIIIBED BY THE DEPART7�¢\T OF LOCAL GOVEA�,•fE�T FI\q\CE IC41.1 '2-8.1
Individuals and married couples are limited to one 6omestead standard deduction. As the receipt of this
deductiou becomes more beneficial, there is more incentive than ever for homestead fraud. Hbmestead fraud
«causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive tli.e homestead
standard deduction to verify that they� are eligible to receive t6e benetit and to provide additii�nal identifying
information necessary to allow county government to better monitor homestead 5lings. This information
�vill be kept confidential and can only be accessed by authorized county of6cials. The Deparitment of Local
Government Finance will use this information to create tools that will help county officials eliminask /
homestead fraud. � ��
Tainarer \ame
Nicholaz J Dicus
Prooem� Address
CARITHERS RD
PRRJCETON IN 47670
Sute Percrl \'vmber
26-0533300-000.811-027 PTSW 3311�0 1.657AC
Cd �
Complere and return to: I�l�(�A���,p������Q�1�,�I�Ei�wuiiu�iiiu�uiwiuu
GIBSON COUNTI' AUDITOR, 101 N MAIN PRINCETON L\ 47670 �
�
Dela«)
Each undersigned ceRifies, under penalty of perjury, that the above and foregoing infortnation is true and correct and that he or she is eligible to receive i
homestead standard dedudion on this property. Each undersigned also understands that, by claimin9 additional homestead dedudioiis unlawfully, he or
(�`�`�-
_ � CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
t Stata Fwm 5473 (R614-03)
' Pmscribed by iha DepartmeM of Local Govemment Finance
� INSTRUCTIONS: See reverse side for �ling instructions.
o�
,�5�
�O
FORM YEAR
HC10
I(We) � ceRify Nat on the 1st day of�.Merch, 20_
I(VJe) occupied es our prindpa
Have a benefidal interest in the entity that is liable for the property taxes on the properry and Nat owns Ne property or is buying under a conUact.
If buying on conireG, Fee Simde ownefs name
Recordels ofice where conVaG is recorded
::'t�= �+'���:,"f, �-a�'��'3���`%:`'�`��"��`d'::� -:PiiOPERT,Y+DESCRIP.TION.
County 'N ToxnshiP T'n istritt t
� U�
Parcel number L d 'ption Is the
D ' //-�D 3_/_/0 .��
If any portion of the 25identlal sWGUre or Ne Wnd not exceeding ona (1) acre Nat immediatey surtounds
of Ne pmperty utllized W produce incpne.
Racord number � PaBe
Real properry (,_J Mobile Home (LC. 57.7-n
ire is used to produca income, describe the use end pwlion
.�`-i � il� �'�{'���"�`"�����e� °i �g� � 'SY^TRUETAXc�` �'�t ASSESSEDVALUE HOMESTEAD�v �'�' NON�RESIDENTIAL w ��`
r��`�<,�'���ASSESSOR USE ONLY�� � � .;;,,,-,�y�UE!+'�`� �,�AT 100%OF�-TTYc � �rV/LLUE'"� "�' Y
r,�.: f'�.�;.���:..tr.;e`�.5*3e,.�'�t �s: w.-.. �a-t_...� �.'t € �^i'..�'£�,,:`�.�Yid,VALUE�-H�'
surroundingresdential mp v�imm�ediatety ��� �.- ������� i {y ��?�_ �s
Other land h -. � '�` `�'"� . -
(Z) _,� ..._,�x::;"t?�
Tctal land (Ilne f plus line 2) �g�
r r;� � `
Dwelling (4) =_:� n�„Q� 'i �� ni �r:�i',ynr� .r-�.
Residential improvements or Mnuapy �'�'-� . .�_.,.: . .x 3.: ._ .
Pssessed Mobi7e I Manufactured Home �`�., �.-:.r.+c� ��
Ga�a9e 5 _,` ` .k'�'�'','c„'rr � ?'jo
( ) � �._._ �s�S ;` . �h.�;;.,:. .
; : _ ,�;:; :
.O�ter�impmvemen4s (8) - ��v,i=,'"r._::'��
Tctal improvemen[s (line 4 through liire 6) (7�
TCaI value (line 3 phs line � �g�
I heteby ceAify the above is We, cortect, and � SignaNia of Assessor DaU sipned
complete. -
Veiying ectlon - Slgnewra ofPuditor Date signed
'��"�h�`�%•:::''Y'+`'"'�-.����.�';��.�:;'�"�_ ��r��,-;STANDARO'.�EDUCTION�ALLOWANCE,. � }.:` � � ,� . -
20_Pay20_
Lesser of 12 Homestead
Valuation or 535,000 S
Signawre ofPuditar Date signe0