Homestead_Davis•^ . CLAIM FOR HOMESTEAD PROPERTY TAX
3 ` -y CREDIT /STANDARD DEDUCTION
' State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
FORM YEAR
HC10 �l
'Ne)�certify that on y h 19
e) occupi as our principal place of residence the, ii flowing described re ro er y i h Homestead
Property Tax Credit is hereby claimed: L I (We) owned IL fl b i iinq)under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
property or is buying it under a contract. %1 '& rte,,
CONTRACT RECORDED
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded Record Number Page
Parcel
PROPERTY DESCRIPTION
Township
Legal Description () h -
District (City, town, township)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately su�rou
lure is used to produce income describe the use and portion of the property utilized to produce income.
� A_Fw
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
that struc- '
County
Township
County
Township
esser of 1/2 Homestead
(2)
Lesser of 112 Homestead
Lesser of 1/2 Homestead
Kieby certify the above statements are true. correct and
.Signature
complete. -
Valuation or $1,500
Address (Street. number. city. state and ZIP code)
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
VALUE
Land not exceeding 1 (orie) acre immediately
surrounding residential improvements
Other land
Total land - line (1) plus line (2)
Residential improvements Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
(1)
1991 Pay 1992
19 —Pay 19 —
esser of 1/2 Homestead
(2)
Lesser of 112 Homestead
Lesser of 1/2 Homestead
Valuation or'$2,500
(3)
Valuation or $1.500
Valuation or $1,500
(4)
-
(5)
(6)
(7)
(8)
I hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
-1989 Pay,1990
1990 Pay 1991
1991 Pay 1992
19 —Pay 19 —
esser of 1/2 Homestead
Lesser of 112 Homestead
Lesser of 112 Homestead
Lesser of 1/2 Homestead
Valuation or'$2,500
Valuation or $2,000
Valuation or $1.500
Valuation or $1,500
Signature of Auditor
Y),)
Date Si ned
.s -X 1
v I I ..
•
STATE FORM 535t4(R/TIP) TREASURE,FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.]IM PRESCEWED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC -t.t-'1d1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street
• Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
— T ` ■ more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore,
HEA 1344-2009 requires taxpayers also receive the homestead standard deduction to verify that they are eligible to receive the
,D 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
MAY 12 2011 Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY 1NFOILtlATION
C'�• Taxpayer Name Location Address -
Davis, Benjamin L/Tamara G _
GIBSON COUNTY AUDITOR 607 CHURCH
FRANCISCO IN 47649
4512
Benjamin L/Tamarac Davis 101 11immil 111111011 millP1111I I Pil y[111111111111111011111110 II
PO Box 338 -
Francisco IN 47649-0338
Il�li�'��'II�tlttii�IIIIFIit���'��IIIIII�iI�I�IFII'�'�II�II�I�I�' State Parcel Number Legal Description
26-13-19-201-000.062-005 PERKINS ADD 33PT/34PT
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
—_--_". PAR-12: TAXPAYER INFORMATION -_ .. .. .__
Ovv. t First Middle Last
nen;amin Louis bav'ls
Mailing Address(number and street,city,state,and ZIP code) 0 Same as property address
P o 332
Francisco I zN �7G q
Spouse - First Middle Last
'-mare GOm ► l uOvN S
Mailing Address(Number and street,city,state,and ZIP code) Same as property address '
-RE) . ADA 338 Fra.ncl sco jI NI 47 t-H
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
•