HomeMy WebLinkAboutHomestead_Beasley (3)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
-- State Form 5473 (RS 110-01)
Prescribed by the Department of Local Gm emment Finance
I (We)
INSTRUCTIONS: See reverse side for (ling instructions.
as our principal place of residence the following described real prgl5e ty for which a
(We) owned ❑ Are buying under contract
L iFORM YEAR
HE10
a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
'iMS.c:s- si'�a�, a9*.'� - 'sue -'ci 'fl��'a;.R, - z,F- ,§,5a-33rraribuMSClaSaa
�iCONTRACT'RE_C_ORDED_?�.1��t If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
w`�s*'�x�� ��" ��PROP,ERTY,OWNED,BYCLAIMANTIN; OTHER `COUNTIE§�a= ;��`�•`�..s���'
County Township
County Township
County
Toxnship
eldress (number and sheet, city, state, ZIP code)
Tating ^ty,.town, township)
Parcel number MM \
0 1 a, — WO I � ' CAC).
Legal d lion
I the pmperty in question:
❑ Real property ❑ Mobile Home (I.C.
H any portion of the residential structure or the land not ezceerirrrr}}}}BBBB
of the property ulil¢ed to produce income.
T
one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
'
d
surrounding residential improvements.
w`�s*'�x�� ��" ��PROP,ERTY,OWNED,BYCLAIMANTIN; OTHER `COUNTIE§�a= ;��`�•`�..s���'
County Township
County Township
I hereby certify the above statements are true, correct and complete.
SIV re claimant
eldress (number and sheet, city, state, ZIP code)
;'' ASSESSOR USE ONL
-5*.
` TRUETAX
•.w..
ASSESSED VALUE
...�.se.-R —S
HOMESTEAW
rox. > r
-6 NONiigi DMNTu -�
.
V_ALUEE"`�.
AT.00 OFIIYVALUE�
VALUE'
Land not exceeding 1 (one) acre immediately
d
surrounding residential improvements.
(1)
i
im, 1, � � R'
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
..,,
NO ..•.
Other improvements
(6)
a.
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
..l,' WW, .rte �x „,STANDA.RD;'DEDUCTION ALLOWANCE�.,>
20_Pay 20_
Lesser of 112 Homestead
$
Valuation or $6,000
Signature of Auditor Date signed /
MAIL 1ORM 5M...in/vNI - nREASlIER ItEM 73-IA
APPROVED BY STATE BO-Minn,'AXYR'nTS.!1% PRESCAIm9 BY n2 DEPARTMENT OF LOAF CAtckNMIWT FINASCE IC 4-1.t-t4.1
Gipson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentne than ever for homestead fraud.I lomesteal fraud causes higher tax bills for all:therefore.
HEA 1344-2000 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to prtwide additional identifying informanon necessary to allow county government to better monitor homestead
filings.This information will he kept erntdemial and can only he accecced by authorized county officials.The Depannient of
Local Government Finance will use this information to create ttxyls that will help county otfieiaL.eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Beasley, Sherrill Jon/Gweneth L Life
Est
P O But 242
Francisco IN 47649
4505
Sherrill Jon Beasley
C/O Gweneth Beasley
P O Box 242 State Parcel Number Legal Description
FRANCISCO IN 47649-0242
26-13-19-202-000.019-005 012-00019-00 PERKINS ADO 17/18 PT
to nt Ir II nrI n IItI o I I nor ItIrlorleeltItIttlititlellol
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
GWrn/ET 14 Lott, 1 S6 {3 £- fiS (. E7
�mg Address(number and street,city,state,and ZIP code) - 9 Sartre as property dAdress
Pr). "8 el J 2 4.1 Pk A rtl C t S e o I-- /474 gq Sot, (0, 3 & th16 L- sT,
Spouse First Middle Last
•
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as propeny address
Social Security Number(last 5 digits) Drives License/State ID Number past 5 digits) Other(please specify in Part 4 below)
Suet
PART 3:CERTIFICATION
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 or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date
(( )
PART 4:ADDITIONAL INFORMATION