Homestead_Carlile (4)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
t Stete Fartn 5473 (R6 / 4-03)
Pmsaibed by Ne Department d Local Govemmeni Finance
INSTRUCTIONS: See 2verse side for filing instrucfions.
�'� 1 L,
FORM
HC10
�
�(We) L�—�i��?-��� ��/�i ���� I certify that on the 1 st day of March, 20
i —
I(We) occupied as our principal piace o( residence the following descnbed real property for which a Home�a�,P�pr��Credil is hereby daimed:
❑ I(We) owned ❑ Are buying under wntract
GIBSON COUNTY AUDITOR
` Have a benefidal interest in Ihe enGty that is liable for the property taxes on the property and that owns Ihe property or is buying under a contracl.
If buying on conVact, Fee Simple ownefs name
Recorders ofice where conVact is recorded
Counry
Tavnship
Tating cL(Ufict (ury, fown,
Rewrd
Page
Parcel number Legal description Is the property in Question:
2� -/I-i d-a �4 - aod •/�_3- a 8 ��^�o �-� � P r ❑ Real proPerty ❑ Mobile Homo (I.Q 67J-7)
If any portion of Ne residential sWClure or the Wnd not axceeding one (1) acre thal immetliatety surmunds ihai sWCture is used lo protluce income, desuiba Ne use and portion
ot the propeny utilized to produce income.
County
Tavnship
I hereby certify the above slatements are true, wrrect and complete.
(numberand sfreet, clry, s(ata,
County
Toxnship
����,'��ASSESSORUS ON Y-��'����,�.� ��TRUE�TAX� ASSESSEDVALUE HOMESTEAU �'x NON=RES�DENTIAL�'`�}f
u-`i'�a,� n - �.,.;e...•S�s .tXe°�'_�`i,`-_°�.`..� �"•za��-_�����VAI:UEr�:z,� .�/1T100%OF�T7V�q��VALUE+'r .'�f,i-r,4�_..�`#`-ir«��VALUE":x.�`�"f3�i.-"Zi�"�
Land not exceeding 1(one) acre immediatey �Y' "� "?"� �+^
surroundin residentialim rovemen[s. ��� ����ys� � .u'��`�4 Y�`
9 P _ .'„'�e�Y�������+-:'��'.
Other land �2) J-�.�,�.-�����
S G4Y9:v"'Y ti. �hl.�v
Tdal tand (line 7 plus line 2) (3�
., 's� 3 i.'+ Yr ro= f..�
s� '�Y. .;L^� '} . � .y r'.;
Dwelling �4� `�'�✓ � �"Y,
�Residentlal improvements or Mnuaily ^ � � �r- ��'�-�"°�����`'�'�'
Assessed Mobtla / Manufachired Home Garage 5 v..s ,... �i .. �''�'�" �;
( � .s�`.(�3�`..''4�1 � - �4�}9��
:��.N.._ ' .
s:x <:��s'-:%` -iz
Otherimprovements (6) ���3�; ;-�'�
- _�; _���s
Ttlal improvements (line 4 through line 6) (�)
Tdal value (line 3 plts line � �g�
I hereby tertify the above is W e, correG, and Signature of Assessor Date signed
complete.
Verifying action - Signature oflwditor Date signed
'� "`-��P-�..� --.�n_�:._.'��i�.s-�?�=�.ar��Ld�.�._'vSTANDARU'DEDUCTION�ALLOWANCE.;.t� � _�v��� `R=-"' - �`,'
�..�-F�,.. ._., ._.. 4�,ra..�.�-�`c_--�, ..�.�''L�r�.��
20_Pay20_
Lesser of 1/2 Homes.ead
ValuaUaf or E35.000 S
Signature oflwditw ' _ Date sgnetl
Sf.�iEiORM5i5691R:1:L91 TPFASUf(plfqUlTSln
APP20YmBT Sf.�TEBWNDff A0.V)\'IS.:I+M pREXR0m8Y TIIE OfDMiME\T6 LCCAL W VQl\T�TT IL\�TCE F61.1 ::.e.l
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this •
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead
,�fraud causes higher tas bills for all; therefore, HEA 1344-2009 requires taxpayers �r•ho receive the �
homestead standard deduction to verify that the}' are eligible to recei�•e the benefit and to provide
additional indentifying information necessary to allo«• county� go��ernment to better monitor homestead
filings. This information �vill be kept confidential and can only be accessed by authorized county officials.
The Department of Local Government Finance �rill use this information to create tools that will help
county officials eliminate homestead fraud.
Addrcss (numbcr and sveet, city, stare, and ZIP code)
70'�l 1.J �S�.t- �t �,i
Parcel Number
� � -1 � —i�=ao�/--�.�-/_,�� - DaA`_
SEP 272013
� �
ONrer �`\��j`,J/��7 First � Middle �IBSON COUNTY AUDITOFd,ast
7 i��Q�-�e..
Mailine Address (numbcr and sveet, city, state, and ZIP code) � Sarne as property address
'�d (,J ��f �.-��-f� �f.
ecwity Number (lazt i digits) Drivers Littnse/Stace [D Number Qu[ 5 digia) Other (pleue specify in Part 4 below)
56�
Spouse First Middle l.ut
Mailing Address (Number and street, tiry, state, and ZIP code) � Sarne az property address
Social Secunry Number (last 5 digits) Drivers License/5tace ID \umber (laz[ i digits) Other (pleaze specify in Pan 4 below)
Sme
� . . �
Each undersigned certifies, under penalty of perjury, that the abo�•e and foregoing in(ormation is true and correct and that he or she is
elieible to receive the homestead standard deduction on this property. Each undersigned also understands that, by claiming additional
homestead deductions unlawfully, he or she may be liable for back taces and substantial financial penalties.
Umer I� n e Date Telephone
9-z��3
S use Signamre Date Telephone
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11 � �' 1
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