Homestead_Houchinsf
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5-92)
r I6
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
FI
CERTIFICATION STATEMENT
I (We) ertity that o th t day at , 19_
I (We) occupied as our princi place of residence the following described real property for which a Hom claimed:
❑ I (We) owned ❑ Are buying under contract GIBSON COUNTY AUDITOR
❑ 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.
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township -
Taxing district (dry, town, township)
P
I n r
Legal description
If any portion of the residential structure or the land net exceeding one (1) acre that inunedialeTy surrounds that structure is used to prod" income, descn the use and portion of
the property utilized to produce income.
- 3 i 9- Boa -ate. 093- 45I!!57_5"
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
,ereby certify the above statements are true, correct and complete.
Si cure t
K
Address ( tuber and street, city, state, ZIP code)
O. �a /38 Freg )c /5cc , =N. 1176119
ASSESSOR USE ONLY
TRUETAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
- Lesser of 1/2 Homestead
Valuation or $2,000
$
Signature of Auditor
Date signed /,
V
STATE 111R.M!_,N'sic II"MI TREASURER FORM 73-IA
.APPROVED BY TIE BdIARD nEAny X NT C.`mw PRFAAIBW BY Mr DEPARTMEMT OF LOCAL(ASBRYMFAT FINANCE IC LI.I-r-tl
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndividuaLs and married couples are limited to one homeoead 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■erifv that they are eligible to receive the
benefit and to provide additional identifying inform:mon nemvary to allow county government to better monitor homestead
filings. this int'rnotion will he kept confidential and can only be accessed by authori>ed county officials.The Department of
Local Government Finance will use this information to create tools that will help coma officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Houchins, Bentley W �I
PO Box 138
Francisco IN 47649
4513
Bentley W Houchins
P O Box 138 State Parcel Number Legal Description
Francisco IN 47649-0138
itInIlnuIuIInuInIItIuIl ��u��t�n�nt��t�n�t�ttt�� 26-13-19-202-000.093-005 2OPT/211PT22/26PT/25 ADD
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
0EAll L E y GrJ fi y,UE oaCifI fV S
•rg Address(number and street.city,state,and ZIP code) - - - Same os property address — - -
/00, 150-4 / 3g ; 300 w. sc400 / s- r ,qNC/5C ° / N. I/76Y2
�
Spouse first Middle Last
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) Other(please specify in Part 4 below)
sthe
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 Sigma / Date
( )
PART 4:ADDITIONAL INFORMATION