HomeMy WebLinkAboutHomestead_HaakeCLAIAA FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Smte Form 5173 (R6 / 4-03)
Presalbed bythe Depertrnerrt d Wul GovemmeM Finarwe
INSTRUCTiONS: See r3fora� tids puf�p itabu8'pu,
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certify Ihat on tpe jstda�oi'�elarch. 20
I(We) occupied as our prindpal place of residence ollowing described real property tor which a Homestead Pro e�y T � he�reb ed:
���/// G�SOt���i�'Sf nw�`l�in
L� I(We) owned ❑ Are buying under co act �
�� Have a beneficial interest in the entiry Nat is liable (or ihe property taxes on the property and Ihat owns the property or is buying under a conUaG.
If bu�ring on coniracl, Fee Simple owners name
Remrders olfice where mnirad is recorded
Counry
7amship
Taing
P�ar,ce�,lry mbe�� I Legal C� Xh � O�/� ^ I Is the pro �
C�J� � % 0 - O� �}�i ' iuvi
H any portion al Me residenllal sWCture w the land not axceeding one (1) ave that immeC� t� rrounds that s i
ot the proDerty Wlized tn produce incame. l0
Remrd number � Pa9e
Real Droperry ❑ Mobile Homo (I.C. 61.7-n
ire is used to praduca inwme, descrihe Ne use and porUon
I� � aG-ir-v9-��o-c�.9ao-oa� (
�t' � � ASSESS�OR�USE ON Y �``���i� ��UE TAX�' � �ASSESSE� VALUE '�HO(dESTEAD � � yNON=RESI0ENTIAL�� �J+
y�,��-,�� ��,�;� ,����'��' �w._VAI:UE�j,-i$§t�� ^AT 700%OFyTSV� �.�;VALUE,�.� ��J�k,ty`.�`�VALUE��;�-`��
Land not exceeding 1(one) aae immediatety ' ' 7`'� �� ��',=�' �3°" �"�.�t�
surrounding residential improvemenLs. (� � �y�-�� �� � � ��°.-�`�, rrF;
Other land - � '� '•�"����'�
(Z) >;�°�e�.E:�;eL�
-�va-fir A.7�-y� �
Tcial land Qine 1 plus line 2) �3) �
� �rti ,r e��_����#i ::T
Dwelling (4) �L�,G4i��� �'f- � �;;
'ResideM7el improvements orMnueOy '� `"� '=�'- '�'�`'"
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Meeafed Mo68e / Manufat4ued Hmro Garege (5) t� �� a. ✓�* :E:� 3�'�'�
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Oiher improvements (6) � s� �..€s,��
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TUaI improvements (line 4 fhrough line 6) (��
TUaI value (line 3 phs line n (g�
I hereby certify the above is We, corred, and Signature o(ASSessar Oate sgned
complete.
Verilying action - Signature of �W 4iW r Date signetl
r:�"�>,�"�F°.'.'.�-"�__-`�.s«�-t ��-e.:�ic��}� ;`'��,�;`STANDARU':DEDUCTIONAL'I:OWANCEt:',%�". � � " -�' '� �`_
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20 _ Pay 20 _
Le>ser d 1/2 Homestead
vaivauon or 535.000 5
Signatureof.Liditw � Datesigned
STAiE FOMf A569 (RllB-10) TAEASURE0. FORN TS-IA
APPROVED BY STAiE BOARD OF ACCOUMS, 2009 PRESCRIBFD BY T}IE DEPART\¢\T OF LOCAL GO\'ER.\:�\T Fl�A�C!'rK11:1-32.;.1
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Iodividuals and married couples are limited to one homestead standard deduction. As the receipt of this
��aduction becomes more beneficial, there is more incenti��e than ever for homestead fraud. Humestead fraud
•causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
standard deductiou to verify that they are eligible to receive the beoefit and to provide additional identifying
information necessary to allow county government to better monitor homestead Tilings. This information
will be kept confidential and can only be accessed by authorized county officials. The Depariment of Local
Government Finance will use this information to create tools that will help couuty officials eliminate
homestead fraud.
Ta�oaver \ame
HoW�ard H Haale
Coneple(e and retutn m:
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o w R,
Mailv+g na nu (evmEer artl streat. �
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Social Seqairy NunDer �Iast 5 a1c14
Prooem� Addrns
4082 W SPLIT RAIL LN
PRINCETON IN 47670
E��7:7"i�i77
26-II-09-300-003.920-027
Le?al Daerintir.n.
M C ROBER'(S OLD
RD LOTS 617
��niin�3CC��J��n�oaDii�n�i�!W"!L!!!�l��,�L1i►iinu
GIBSON COUNTY AUDITOR, t01 N MA[N PRINCETON IN 37670
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Each undersigned certifies, under penalty of perjury, that the above and foregoing information is true and correct and that he or she i< eligible to receive I
homestead standard deduaion on this proDerty. Each undersigned also understands that, by Gaiming additional homestead dedudions unlawfully, he or
she may be liable for back tazes and substantial financial penaliies.
O.mer1 Sipracme Date Taleplpna
5W�5a SW�:ure
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