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Homestead_Ellissurf o i CCLAIM FOR HOMESTEAD REDIT /STANDARD DEDUCTION RTY TAX �� il• State Form 5473 (132 15-92) 6 INSTRUCTIONS., See reverse side for filing instructions. - FORM HC10 YEAR CERTIFICATION STATEMENT I (We) certify that on the Istt day of March, 19_ I (We) occ ied as our principal place of residence t f I ng described real property for which a Homestead Property Tax Credit is hereby claimed: (We) owned ❑ Are buying under contract ' .f + Y( X11 z- ❑ Have a beneficial interest in the entity that is liable for the property fazes on the property and that owns the property br i5 b ng r F contrat. CONTRACT RECORDED �. If buying on contract, Fee Simple ownefs name - i Recorder's office where contract is recorded Record, ranber:: - '-; Page PROPERTY DESC TION County Township T district city, town, township) l al description If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion of the property utilized to produce income. 7- 06J PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES County Township - Coun ignatu o claimant ereby certify the above statements are true, correct and complete. - !41d d (number street, ci , state, ZIP code) - d. 3 ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON- RESIDENTIAL VALUE VALUE VALUE VALUE Land not exceeding 1 (one) acre immediately (1) surrounding residential improvements. Otherland (2) Total land (line 1 plus line 2) (3) Dwelling (4) Residential improvements Garage (5) _ Other improvements (6) Total improvements (line 4 through line 6) (7) Total value (line 3 plus line 7) (8) I hereby certify the above is true, correct, and Signature of Assesor Date signed complete. Verifying action - Signature of Auditor Date signed STANDARD DEDUCTION ALLOWANCE 19_ Pay 19 Lesser of 1/2 Homestead S luation or $2,000 Signature of Auditor D7igned •� — SINE FORM S)!MIR'/S O TREASURER FORM 11A APPROVED BY SIAIE BOARD OF ACCOUNTS.9w rUSWBm BY fir DEPARIMER OF LOCAL rOVERMMnnn FINANCE IC VET-ra.l Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS PRINCETON IN 47670 Individuals and flurried 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 rat bills for all:therefore. ® HEA 1344-7009 requires taxpayers who receive the homestead standard deduction to verily that they are eligible to recene the benefit and to provide additional identifying information necessary to allow county government to better monitor homestead fling.This informainn will he kepi conlidential and can only he accessed by authorized county officials The lkpannxmt of t Local Govertunent Finance will use this information to create tools that will help county officials eliminate homestead fraud. FILE PART 1: PROPERTY INFORMATION Taxpayer Name Property Address APR 7 LULU Ellis, William L/Peggy D I'O Box 137 j i/ _ Francisco IN 47649 1725 !�'/ Aga" gON COUNTY AUDITOR Williat/Peggy D Ellis P O Box 137 State Parcel Number Legal Description Francisco IN 47649-0137 If�rf��tt t�t��ttt�tt��t�tt�� ��tt licit tt'ttlltltLtl ltf ttl 26-13-19-201-000.327-005 012-00327-00 PERKINS ADD 31/32 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. PART 2:TAXPAYER INFORMATION Owner I First Middle Last Mt4rr /tn/v aim A ddress(number and ty,state,and ZIP code) ame as property address �© Eax _ J3 Spouse First Middle Last Mailing Address(Number and sweet,city,state,and ZIP code) Same as property address Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below) See 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 liable for back taxes and substantial financial penalties. Owner l Signattlre�/2 �ei Da .v ( / PART 4:ADDITIONAL INFORMATION •