Homestead_Davis (2)1
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
s State Fonn 5473 (R12 / 6-09)
�O Prescribed by the Department of Local Go"niment Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
i'iI rR
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-CERTIFICATION STATEMENT
I (We)
q¢ftl s, triNZ4Wcupied as my (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Property �Tlaxx Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
�p'y�y[, /��[�/'j��f•
�I (We) awn ❑ Am (are) buying under recorded contract
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❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
V
GIBBON COUNTY AUDITOR
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
CONTRACT ••r
If buying an mritrad, Fee Simple owners name
Recorders o1Gce where contract is recorded
Record number Page
PROPERTY DESCRIPTION
County Township
Taring district om town, township)
Legal
Parcel number description Is the property m question:
_ _ _ z0 Z 3 1
property ❑ Annually assessed moWe lame (IC 6.1. 1-7)
If any portion of the residential straws a the lard not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utd¢ed to produce income.
a7lo- /3- /9-2oz -000 .Z3
oQ
PROPERTY BY CLAIMANT IN OTHER COUNTIES
County Township County
Township
I hereby certify the above statements are true, correct and complete.
Signature afrclaimant
A Address (n beraM Street state, and ZlPCOda
/K L VV
0
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE
100% OF TTV
I ESIDENTIAL
HOMESTEAD NON-RAT
I VALUE I VALUE
Land not exceeding 1 (one) acre Immediately
,��vA``s+'f 's' �:".', +p
"j,::
surrounding residential ion rovements.
i�j.7
Other land
(2)
1 yF +k'
Total land (line 1 plus line 2)
(3)
Dwelling
(4),�s'4�„-
:YFI$' }`W M�'if .•'T rile
rN°kfirz,7'�yro;
Residential Improvements or Annually
Garage
`v ,. z. '"�53h'�+`<''�<�=•=
Assessed Mobile I Manufactured Home
(5)
Cia3�'sr•t*� -Te'"c S?f,
Other Improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
verifying action - Signature of Auditor
Date signed (month, day, year)
STANDARD DEDUCTION
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or 545,000
'
NoMithstandug any aherprovlsion, the sum of the deductions provided in IC 6- 1.1 -12 to a mobile fame that is
S
not assessed as real property or to a manufaowred home that is not assessed as real property may not exceed
one -half (112) of the assessed volue of the mWe home ormanufactured home.
Mof Audits
dau
Date signed (nanth, day, year)
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STATE FORM 53569(R2/5-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 106-1.1-22.8 I
i. IMPORT°ANCNOTICEITO'I ONIESTEADTROPERTbrDWNERS. ',
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
«causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
standard 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.
t tt t„ yr^,<a 'PPARTI PROP,,ERTYiINEORMATION4tiir, -. ,;M - ' -" w ,
Taxpayer Name Property Address State Parcel Number Leeal Description:
Steve Davis 602 W Main 26-13-19-202-000.323-005 / OLD PLAN 31
Francisco IN 47649 (/ -7
Complete and return to: InL1Il1IIJ I1II1I11r00.IIt.1I1I1 1111Iih!11I1/UDDOUlmffhII 11fl
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 Lill II: IJ ll L LI II IIJ II. IL
i v 4 22'4:7 T1h : A :e-. pr,A ai ;tty.,0, t -.d'' h
-, +• .PART 2:.TAXPAYER7NFORMATION'��: � •
Owner I First Middle Last
S}eve-n, Er g K b a,v is
Mailing Address(number and street,city,state and ZIP code) Same as property address
Po e 5 ■ -Gino s CO s1-) Li"Ro Li Q
Mailing Address(number and street,city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers License State ID Number(last 5 digits) State Other(please specify in Pan 4 bebw) I
- m .. . . . -< °.-Writ,. .PART..: 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 Signature c Date
( )
. F" , '11 -!PART 4;'ADDITIONAL INFORMATION -' I-
FILED
•
MAY 102011
c.'J.I
CIDCON CUON 111 AUDITOR