Homestead_Schmitt (4) M METORM!!H IIL-/aVll TPFASDRER FORM SIA
APPROVED BY'TATE IMIRD Or MYYiUNTS.R',a PRatOno BY THE DEPARMT:Tr(4 L(ML GOVERNMENT FINANCE IC w I.I-r-LI
('1 N Main County Auditor
1001 N IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
F' IN 0 Individuals and married couples are limited to ore homestead aandani deduction.As the receipt of this deduction becomes
�-y more beneficial,there is more incentive than ever for homestead fraud.Ito mead fraud causes higher tat bills for all:therefore.
® HEA 1344-2009 requires taspavcn who receive the homestead standard deduction to verify that they are eligible to reecho the
benefit and to provide additional identifying int-warn n necessary to allow county government to better monitor homestead
filings.this information will he kept confidential and can only be accessed by authori,ed county officials.The Depannaent of
MAY3 - z U 1U Local Government Finance w ill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
e`, to Taxpayer Name Property-Address
GIBBON COUNTY AUDITOR Schmitt, Alice L
RI Box 273 13 I
Francisco IN 47649
4801
Alice L Schmitt
3026 S 750 E State Parcel Number Legal Description
Francisco IN 47649-9054
�t1u11ut1111tIJrJlJn1t1u11nu1t1n1tt1n1r1t111rt1aJ1 26-13-28-300-001.465-004 002-01465-00 PT NW SW 28295.00 AC
X C-1
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
ifT 1-i- l iC�n� � �C
tg Address(number and street,city,state,and ZIP code) - -- - EI-Sa-r-ne as prupem nddr s— --- —
30ze, s 7.5oEt 1 �
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
5=
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury.that the above and foregoing information is true and correct 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 nraay be liable for back taxes and substantial financial penalties.
Owner 1 Signature Date
PART 4:ADDITIONAL INFORMATION
•'r'.r„�..t. S i3O c,cn Y,.✓Et-
i
aE
-, CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State form 5473 (R2! S92) ,
�!' r
INSTRUCTIONS: See reverse side for tiling instructions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT
n
I(We) Ce // certi that th _
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I (We) owned El Are buying under contract DEC 2 2 G
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pro rty or is b "eraco
CONTRACT RECORDED OU"II
If buying on COnbact, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
S o->
Township
Taxing dis .ct (dry, t ,town " )
Parcel n ber
mot- / 6T=o
Legal description
- - -cV /-
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
'
ereby certify the above statements are true, correct and complete.
Signa[ur of davnani
Address (number and street, city, state, ZIP code)
Aea 2,7 � 6�9
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line 1 plus line 2)
(3)
.
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
-
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 19
Lesser f 1/2 Homestead
V ua'on or ,000
S
Signature of Auditor
Date signed
1 -Y�- �a
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