HomeMy WebLinkAboutHomestead_Bailey (10)°°' CIAIM FOR HOMESTEAD PROPERTY TAX
r - > � CREDIT/STANDARD DEDUCTION
State Fwm 5673 (RB! 7-07)
y�ns � Prescribed by Ne Oapartmerri of Lotal Governmenl Finaxe
INSTRUCTIONS: See ieverse side for filing insWcfions.
Y EAR
HC10
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��e) �`'� �� certify fhat on fhe 1st day of March. 2(1_
I(We) occupied as our prinapal place of residence the following ribed real property for which a Homestead Property Tac Credit is hereby daimed:
,I(We) owned ❑ Are buying under contraU
Have a benefidal interest in the entity Nat is IiaWe fw the property taxes on the propeAy and that owns fhe property or is buying under a contract.
Counry
Tovmship
Parcelnumber legaldescnptlon .
' i SE /JGJ /8 -d _
If any portion af the ruidenlial sVuclure or Ihe land not ezceeding one (1) acre that
of Ihe propeity utiGZatl In pmduce inwme.
�!o-�a-/�-�oy-oo� �17a2. va-b�
Counly
Tavnship
I hereby certify the above sfatements are true, cortect and complete.
(number aM sfineG cdy, sfafe, and Z(PCode)
Tazing dislncl
Ci �/� � I Is Ne property in queslion:
O ❑ Real propertY ❑ Mobile Home (/C &f.7-�
imediately surtounds lhat sWcWre is usetl ta produce income, descnbe ihe uu antl portion
o��
5a-
a�°
Twvnship
•- •
� � . � � �
� i , •
Land not ezceeding t(one) aae immediately ,- p; �`^ �9' ` .
: t.-'.`
surrounding residential improvemen6. (�� � = • - .-�
Other Wnd (Z�
Tdal land (line 7 plusline 2) (3�
-�-c,i. : - - .
Residential imprrnements or Mnualty �e���� (4) -
Pssessed Moble / ManuFdUured Home .. .. ' ... ..
Gara9e (5) • �. , . -
Other improvements (6) ._
Tcial imprrnements (line 4 through line 6) �7�
Total value (line 3 pl�s line n �g) (
I hereby certi y the abwe is We, correct, and signature otassessor Date sgned (manm, day, yea�
complete.
Vuifyirq acUon - Signalure af FwdiWr Date 5igned (marN, day, yea�
• � . - � � � • •
<� _ pay 20 _ 45.000 for 2007 pay 2008 42.000 for 2070 pay 2077
Lesser of t l2 qq 000 for 2008 pay 2009 41.000 for 2011 pay 2012
Homestead ValuaCOn $
w 43,000 for 2009 pay 2010 40,000 payable after 2012
SignaWre of �inr Daie sgned (marfh, day, yearj
STATE FOR.N 5:569 (it?B-09) iRF.1SU0.ER FORAf TS-IAI
APP,^.Ot'Fb Bl' STATE BOAAD OF ACCOU`T5. �009 � PRFSCRIBFD BY THE DEPMiNfEYf OF LOCAl. GO\'ER.\'�IE�T FIN,V:CE ICbl.l.>1-8.1
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[ndividuals and married couples are limited to one homestead standard deductioo. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpa��ers who recei��e the homestead
s aodard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
iuformation necessary to allow couoty government to better monitor homestead filings. This iuformation
will be kept confidenNal aod can ooly be accessed b}' authorized county officials. The Department of Local
Go��ernment Finance will use this information to create tools that �vi116e1p county officials eliminate
homestead fraud.
: R�L'3t�: ° �YlTLo�`I " � "'� �
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Taaoarer Yame Pm em� Addras State Parcel \umber Lasal Daerinrion:
Steve 1 FI[hlan os 285 A 26-12-18-104-001.472-028 019-01472-00 PT SE NW I8-bt0.08
Owen 6� pC
Complete and remm to: \
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
. :-,k � � e'.5:- ?��b �� o✓.r� •j.;.
�G�n:
Owria f �•Firsl hlidale LaC
!` I 5� Q.A� �O� . Ai�� Y
rnaaaq aemass (�,,,e� �e meat o+r. s�a:e �,a ZP coae) � � ' i
u8�iie as pvpaM1y aEOrass
i( 3 ��-k� s�� �uc�.
$a�l $eGaYy Mvpbe� (lazt 5 tllgib) D�i-refs Licnue Sta;e ID MmDer (last 5 tligib) �e �� (P�0a38 3p001Y n Pd114 pEbw)
- �� �- �
Spouse Firs� MiECIa Lest
MadmO PGC'ess (rnn. ber aM sbeel �Y. state anC LP cnEe) ❑ Same as P��M�b aEtrass
Sod� 5�rey m.�eer lias� 5 atyu� DeivNe L'cPnae State 10 Nun�ar Qut S d9ib) sma ou�r (q� �acay:, aen a miow>
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{':.�Y��f� . � � �� �O � � B 4�� � F Y.:{��! 13x�� ..�4wl.b_ _ __.
Each �undersigned certifies, under penalty of perjury, thatfthe above�and foregoing information is true and correC and that he or she is eligible to receive the
homesiead standard deduction on this property. Each undersigned also understands that, by claiming additional homestead deduCions unlawfuly, he or
she may be liable for back taxes and substantial financial penalties.
Ov.Mt f S�C�� � � Q Date �— �—� O 7ekp�
s� s�a.a o� ra�y�
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