HomeMy WebLinkAboutHomestead_GoldsberryCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R61403)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
I (we) k---A LL4-41 certify tfigt on the I st-diiy of March 20' 1
1 (We) occupied as our principal platflrete=cee following described real pro for which a Homestead. P/T=per�ty3l��Credit is hereby daA6j
I (We) owned ❑ Are buying under wntract P(�
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 under a contract.
M NTRAGTT'RECORDED,
If buying on contract. Fee Simple owners name
Recorder's office where contract is recorded Record number Page
County Township Tadni t (city, town, fowmhip)
Pa[tel nurriber le�,l escripbo the pro_ rty . questJon:
Olc� —co A5U —dD I re 7iaw eal property ❑ Mobile Homo (I.C.6-1.1-7)
If any porfion of the residential structure or the land not Exceeding we (1) acre that inurriediatelf surrounds thatitructure is used to produce income, describe the use and portion
of the property utilized to produce income.
PRCIINERT-t6WNECIB-k
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature
pf claimant
J
ress (number and street, city, state, ZIP code)
L( I LC4 IN
k —
JE i A
LV
ASSESSED
.
WY6Wr gSTE — a U
P
A&YEI
T 192_ OF -
UE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
W —m
Dwelling
(4)
Residential Improvements or Annually
Assessed Mobile I Manufactured Home Garage
(5)
Other improvements
(6)
Kp
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Data signed
complete.
Verifying action - Signature of Auditor
Dale signed
20 _ Pay 20 _
Lesser of 1t2 Homestead
vauatiort or E35.000
S
Signature Of Auditor
Datesigned
' flan rORN!)w129vW TRI:SUPfA PORN 73-1.1
.\PPB1wEn BYaraTE B1tRoo1-MYYRIsTc.arn PITIOUBFn BY ME BFPARTMENTFLOCAL CAVERNXR.l FINANCE IC/.1.1-$:4.1
Gibson County Auditor
11;1 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive don eser for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
ail
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will be Lepi confidential and can only he accessed by authorized courtly officials.The Depannrnt of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
_ Taxpayer Name Property Address
Goldsberry, Charles J/April R - /
1'o Box 277 l/
'rancisco IN 47649
4593
Charles J Goldsberry
P 0 BOX 326 State Parcel Number Leila! Description
FRANCISCO IN 47649-0326
Illiiiiiii1111111111111111II II,IIIIlrllriiiiiiIII III 26-13-20-101-000.253-005 012-00253-00 SHOP ADD 32PT/45PT
X
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
flp mg Address(number and street,city,state,and ZIP code) Same as propcny adores, — - •- - ----
To ED K �Ja-l.p NCO H Cen-1'es Si- 4GLn c i sc o 11...1 41'7 w 4!-c{
Spouse First L Middle Last
AM" k L tRenee- C-cbIdsbe.rry
Mailing Address(Number and street,city,state,and'LIP code) U ❑Same as property address .
- --,
4'0 Box_ 3nf_Q aco N CenMc - -1-rcunc;sco IN 4n1r'gel
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.
Owner I Signature Date Telephone
-' 1 -------, 51,I0 l to (8la ) Loll— 388 5
Spouse Signature Dat- Telephone
i,. t st 10 hp . (eo P.-) t4 1l - 1g rl I
PART 4:ADDITIONAL INFORMATION
.