Homestead_GashCLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
CREDIT/STANDARD DEDUCTION HCto
Sute Form 5473 (RB / 1-03)
Prescribed by ihe Departmenl ot Local Govemmen� Finance �� � J � �
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INSTRUCTIONS: See reverse side !orlling insfnrefions.
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' I(VJe) certi(y thal on the 1st day of March, 20_
I(We) occupied as our prindpal place oi residence the Ilowing descnbed real property for which a Homestead P o�perty Tac Cre�it i�reby da med:
❑ I(We) owned ❑ Are buying under contract GIBSON OU TYpII�1�T��1
� Have a benefidal inlerest in Ne enUty thal is liable (or the property taxes on the property and that owns lhe property or �s �uNng under3amB�
If buying om m�irad, Fee Simple owneYS name
Recwdefs office where canVad is remrded
Tavnslrio
Legal
i�ng eavca (ary,
N any portion of Me resiAenUal aW cWre w the land not exceedinp one (1) aae ihat immediatety surrounds that
ot Ne property utllized b produce income.
Record number � Page
question:
Real D�aOerty ❑ Mobile Homo (I.C. 6f.7-n
is used W produce income, descnbe Ue use and poNon
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more benercial, there is more incenti��e than ever for homestead fraud. Homestead
�fraud causes higher tas bills for all; therefore, HEA 1344-2009 requires taspayers who receive the
homestead standard deduction to ��erif� that the}' are eligible to recei��e the beneft and to provide
additional indentif}'ing information necessary to allo�v county� government to better monitor homestead
filings. This inTormation n�ill be kept confidential and can onl}� be accessed bl' authorized counh' officials.
The Department of Local Government Finance «�ill use this information to create tools that will help
Addcess (numbcr and street city,
Parttl �umber
county of6cials eliminate homestead fraud.
and ZIV code)
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Address (number and strect, ciq•, stam, and ZIP code)
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(Number and street, city, state, and ZIP caie)
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S�p 3�T013
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Same az propert}•address
Part4
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� Same az pmperty addrcss
speci(y in Pan 3 below)
Each undersiened certifies, under penalry of perjury, that the above and foregoing information is true and correct and that he or she is
eligible to recei��e the homestead standard deduction on this propert}•. Each undersigned also understands that, by claiming additional
deductions unlawfully, he or she may be liable for back taxes and substantial financial
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