Homestead_Ballard (4) SAE FORM!JIM IR:t!7I TREiSUIER FORM 71-IA
APPROVED BY 5501LOCARD OFMtXPNrS.-nun PIFYIIBED BY till DEPARIMENIT OF LOCAL CMERTMENr FINANCE IC4.1.I 424.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual>and married couples are limited to one homestead aundatd deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ner for homestead fraud.Ilome teal fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers who raeeive the homestead standard deduction to verify that they are eligible to reecho the
benefit and to provide additional identifying. informaron necessary to allow county goverment to better monitor homestead
filin>_s.This information will be kepi confidential and can only be accessed by authorized count'officials.The Depannienu of
Local Government Finance will u.e this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Properly Address
Ballard, Jan
216 II Oak
`/u1 Princeton IN 47670
854
Jan Ballard
216 E Oak State Parcel Number Legal Description
Princeton IN 47670-1610
Illttllrrllllirlltrllll IIIII 1111 IIIII III 7 26-12-07-201-001.573-028 019-01573-OO WARNOCK5 PT
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.
• PART 2: TAXPAYER INFORMATION
Owner I First Middle
Ba.,60 Last
ig Address(mum. and street,city,state,and ZIP code) ❑ Same as property address
02. I(e e. (9 f Sr.
Last
Mailing Address(Number and street,city.state,and ZIP code) ❑ Same as properly address
Social Security Number(last S digits) Driver's License/State ID Number (last 5 digits) Other(please spc ify in Pan 4 below)
sate
PART 3:CERTIFICATION --�— _ --1 —
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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 is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he# she may be liable for back taxes and substantial financial penalties.
Owner 1 Signature Date Telephone
��� (:
•
a��` .
. �f
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2l S92) .
INSTRUCTIONS: See reverse side (or (ling instructions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT � � �{ �.� ��' �
I(We) c� t���n fie"T�t`day of March. 19_
I(We) occupied as ou rincipal place of residence the following described real property for which a Homestead P/ro`pe Credit is hereby claimed:
❑ I(VJe) owned ❑ Are buying under contract F�� v 7� �
❑ Have a beneficial interest in the eNity that is liable for the property taues on ihe propeAy and thaEowns the property�r is buying under a coniract. .
���tiv: -��.:-�!.X
CONTRACT RECORDED � � �'� ��'�"-:� t �.VUi��v:� •
If buying on contract, Fee Simple owners name
Rearders otfice where conVact is recorded Record number Page �
PROPERTY DESCRIPTION �-
Coun Tovmship Ta�ing dis 'ct iry, 1 wn, fownship)
Parcel number Legal de �pti
S �7 3 flt� � �-�
If any ponion of the resitlential siruc[ure or the land not ex eAing one (1) acra thai immediatety surtounds ihat sWCNre is usetl to produce income, tlescribe Ne use antl poNon of
Ne D�operty utilized m produce income.
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Counry Township Counry , 7ownship
S' na� e ot la'vnant
ereby certify the above statements are true, correct and complete.
�
Addre � mber and sfre t, c, at , Z/P code) � � �
I \ � � ' L �. .1. �., .
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediatety (�� •
surtounding resideniial improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Owelling (4)
Residential improvements
Garage (5) -
Oiher improvemenis (6)
Total improvements (line 4 through line 6f (7)
Total value (line 3 plus line 7J (8)
I hereby certify the above is true, CArretl, and Signature ot Assesor Date signetl
wmplete.
Ventying acuon - Signature of Auditor Date signed -
� � STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or 52,000
a� tli� Date signed
-� aoo