Homestead_GoadCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
Stale Form 5473 (R1216 -09)
.� Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
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1(We) certify �$ e N ocFp 7y pgP7pp r
inapal
place of resi ence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ I (We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant- stockholder of a cooperative housing corporation
❑ 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 r
if buying on contact Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township la5v district (city. town, township)
Parcel camber
al description 19 9 Is the property N W .
Q�,d Real props Annually ssessed nubile tome (IC 6-1-1 -7)
any portion of the residential srru.1 1. or the 1,,cf not exceeding one (1) acre that 6mn i at sbuctu is used prod , describe the use and portion
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of the property ut73ied to pmduce income.
13a
Flo— i3 —i7— 3v3 -000. —OOr
.- OWNED BY
County Township
County Township
I hereby certify the above statements are true, correct and complete.
S' care of claim t 1,
A 11 L_�C'�Y
Address (wmber and street, dry, state, and ZlPcoda)
b Eca '1 0 '' C -o
ASSESSED
ASSESSOR
Land not exceeding 1 (one) acre immediatety m
surrounding residential improvements.
Other land
(2)
ir:•: ;;h- -'.
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
.s;- rgijgy.. -y's ;try
Residential Improvements or Annually
Assessed Mobile 1 Manufactured Hom
Garage
(5)
Other Improvements
(6)
c�v' �• zs' -.
Total Improvements (line 4 through line 6)
(!)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (momh, day, year)
and completem
verifying action - Signature of Auditor Data signed (month, day, year)
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20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Notw,hs,,.dio9 any otherpm,f., th e sum of the dedudions provider! in IC 6-7.1 -12 to a mobile Lame that is S
not assessed as real property or to a manufactured home that is nit assessed as real property may not exceed
one -half (12) of the assessed value of the mobj a home or manufactured home.
Signature of Auditor it L
Data signed (month, day, year)
STATE FORM 53569(R215-09) TREASURER FORM TS-I Al
APPROVED BY STATE BOARD OF ACCOUNTS._'009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.I.22-5.I
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IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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
'pauses higher tax bills for all; therefore, HEA 1344-2099 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.
PARTI PROPERTY INFORMATION
Taxpayer Name Property Address State Parcel Number Legal Description:
Judith N Goad 300 H°Od 26-13-17-303-000.132-005 012-00132-00 SHOP ADD 16
Francisco IN 47649
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
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PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
D` --e n f `700 C�1
Malmg Address(number and street,city.state and ZIP code) Same as property add ess
PO
Muddle Lass
Mating Address(mutter and street.city.state and ZIP code) I Same as property address
E1__{=fQC2
Social Security Hunter(last 5 digits) Driver's License State ID Number(last 5 digits) S a Other(Please specify in Part 4 below)
�— If 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.
Amer t Signature Date
PART 4: ADDITIONAL INFORMATION
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