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Homestead_Fuhrman\ ` \ � � d�p., CLAIM FOR HOMESTEAD PROPERTY TAX ' :;'� � ° CREDIT/STANDARD DEDUCTION : .' y ,� .� State Form 5473 (R2/1-90) " ` �'°" � INSTRUCTIONS: See reverse side for filing instructions. CERTIFICATION STATEMENT FORM HC10 �- YEAR � "I "l I I(We��Qm2�d_XX �_�c��U^4��• �� ce�tify that on the 1 st day of March , 19 � I(We) occupied as our p cipal place of residence the follo ing described real property for which a Homestead Property Tax Credit is hereby claimed 1(We) owned ❑ Are buying under contract Have a beneficial inierest in the entity that is liable for the property taxes on the �� property or is buying it under a contract. ' ' �� - ' CONTRACT RECORDED - on contract. Fee Simple Owner's Name Recorder's office where contract is ERTY DESCRIPTION � Taxing District,�6+;y,itoFvn, township) and that owns the ��c,�J NumOb� /' � O � I Legal Descr ion �/� � (\ � � . �! d (S�AI Ii any portion of the resideniial structure or the land not exceeding one (1) acre that immediately surrounds that struc- ture is used to produce income describe the use and portion of the property utilized to produce income. PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES County Township County Township �I.hereby certify ihe above siatemenis are.true. correci and .� ��i�n t r� � � � number. city, siate and ZIP code) ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE Land not exceeding 1(one) acre immediately surrounding residential improvements (� 1 Oiherland (2) Total land - line (7) 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) I hereby certify the above is true, Signature of Assesor Date Signed correct, and complete Verifying Action - Signature of Auditor Date Signed I 1989 Pay 7990 Lesser of 1/2 Homestead - Valuation or $2,500 STANDARD DEDUCTION ALLOWANCE 1990 Pay 1991 1997 Pay 1992 19 — Pay 19 — Lesser of 1/2 Homestead Lesser of 7/2 Homestead Lesser of 1/2 Homestead Valuation or $2,000 Valuation or �1,500 Valuation or $1,500 of Auditor Date Signed ,�,.v � . � �,.� ia-3�- a STATE FORN 5]569 (R]I8-10) THFASURER FOR\I TS-IA APPROVED BY SiATE BOARD OFACCOU�'IS, 2W9 PRESCRIBED BY THE OEPMTME\i OF IAGL CAVFR\?fENT R.�'A.\CE I[61.1-22-8.1 � , � , , / � 1 � , 1 � , � 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 �uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who recei��e the homestead siandard deduction to ��erify that they are eligible to receive the benefit aud to provide additional identifying information necessary to allo�v county go��ernment to better monitor homestead filings. This information will be kept contidential and can onl�� be accessed by authorized county officials. The Department of Local Governmeut Finance �vill use this informatiou to create tools that �rill 6elp counh� officials elimivate homestead fraud. ' •� �� Tuoa.er\ame Prooerb�Addrn+ SulePamel\vmber LeealDa<rio6on: Randall J/ Debra 5 Fuhmian �ZS W OAK ST 26-12-07-101-000.119-028 CUSHMAN ADD ZS PRINCETON 14 47670 Complere and return to: I�II�IL�J��J�I��V�I��L�I�mIIIl�aii!i�� GIBSON COUNTY AUDITOR 101 N A1AL\ PRL\CETON IN 47670 1 1 Oxnc 1 � F'vst MiEdle Lag � f}N�J!{ L< S° S �,�t-f �vtf2m'��Y Maiti�g A4Cress (rnmEtt aM sveeL tlry. state anE 21P coae) r-` ' �i Same as W�M adtlreu � �i p�r32� .S�.E t�,�j� ��M MaiGng AEEress (nurtEer antl streel dry. state a�b ZIP mEe) r� /�� az a�NY �� LlJ' soaai sea�oq m,nca rys� s apicsl Pivers Licensel5bte ID NurtCU (WSt 5 tlqits) Sne pNer (p1e95! spc[i(y in Pxrt 4 pdox) �G� �y3�-g� Each undersigned certifies, under penalty of perjury, that the above and foregoing information is We and mrrect and that he or she is eligible to receive the homestead standard deduction on this property. Each undersigned also understands that, by daiming additional homestead deductions unlawfully, he or she may be liable for back taxes and substantial financial penalfies. p,My � gy�yre pa� � � ; � � ' t. . _ �, .; � - � NOV S �!�;2 � c.�. - GIBSON COUNTY AUDITOR