HomeMy WebLinkAboutHomestead_Hurst (9)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
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J Su�e Fwm 5473 (RB 14-03)
Prescribed by Ihe Departmenl of Local Govemmenl Finance �1 q
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INSTRUC710NS: See reverse side /or lilinq insfrticlions. i� � kl ��_S `
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.. �(we) cer�ry lhat on the 75( �y�o�iMarch, 20_
I(VJe) occupied as our principal pla of residence the I "ng desuibed real property (or vfiich a Homest�e�ad Property Tac Credit is her/eby imed:
❑ 1(We) ovmed ❑ Ne buying under wntra ,(u ,N�J�� ,,:,.,J�
� Have a benefidal interest in the enti that is liable for the m e taxes on Ihe ro e and that owns the � ����� oi is'bu�in' �under a wntraU.
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�., ° bNTRACT-RECORDED - ��" �'� � �"��.�"'"�'
11 buying om m�tracl, Fee Simple ownefs name
Remrdefs ofice where mntraq is recorCed Remrd number Page
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County Tamship Taing dislrict (ciry, town, t ip
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Parcel num / ' 0/� ^� Leuy� descriptlon I Ne properry in queslion:
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Kl Raal D�o7artY ❑�b0e liano (/.C. 61.1-�
H any poRion of fhe residential sW cWre ar Ne land nd esceetling one (1 J ave that imrt�etliatety wrto/ynd t sW cN)r�e Lt used b produce income, desmhe Ne use and portbn
of Na proPerty uLTized to produce income. /��T ��/
Twvnship I County
I hereby certify the a6ove statements are W e, corred and complete.
eM s7eet, city, Mate,
20 _ Pay 20
Lesser of 1/2 Hon
/ vauanon w 53;
Signature
STATE FORM 53569(R21S-09) TREASUiE,RFOEM TS-TAI
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICU-t.l'_1-8.I
IMPORTANT NOTICE TO PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
reduction 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 taxpayers who receive the homestead
s andard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
information necessary to allow county government to better monitor homestead filings. This information
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
PAR 1: PROPERTY t'FOR,MIATION
Taxpayer Name Property Address State Parcel Number Legal Description:
Lzrryd Hurst 528 W Oak 26-12-07-101-001.596-028 019-01596-00 CUSHMAN ADD 14
Princeton IN 47670 PT/15 PT-
Complete and return to: >\
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2:TAXPAYER INFORMATION - ..
Owner I First !Addle last
LHf2AY 3--(9 -E /10R,s' 7
Mang Address(nunber and street.city.state and ZIP code) -
Same as property address
,S 4 rte . 0/914 S7 12. 9 '76 70
Spouse First . Middle Last
Mailing Address(number and street city,state and ZIP code) Sane as property address
Social Setvnty Number(last 5 digits) Onvees license State ID Norther(last 5 dig Its) Sae Other(please specify in Part 4 below)
•
PART3:'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 1 Signature Date
PART 4:ADDITIONAL INFORMATION -
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