Homestead_IleCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
If It
Ll
I (we) �a sl�v-�LAJ�t �d cerQ that on the ,1 st day of March, 20
:1 occupied as r prinjalblace of r(srenoe the following described real property for which a Homes!el/ad Propeity-Tax Ckilit is hereby chimed:
1 (We) owned ❑ Are buying under contract
il 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.
CINTRACTRECORDED
If buying on contract. Fee Simple owners name
Recorder's office where contract is recorded Record number Page
komm bw N E 6�1 Y 1HEA I m-Afit I h,6T HE Wcou
RfYdCSCRl1PTIdN
County
Township
Taur�ddi Vricll,ty town, township.
Parcal number
Legaidesc io
s the property inifurestion:
0 j Q — 60
t&4
12 Real property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1 acre immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
7-
9- /�/ -
komm bw N E 6�1 Y 1HEA I m-Afit I h,6T HE Wcou
County Township
County Township
I hereby certify the above statements are true, correct and complete.
gnat e o:.f:;cl;qj�;am '
4z
rera; (number and street, city, state, ZIP code)
STANDARDIDEDUC'nOWALILOWANCE
20 _ Pay 20
Lesser of 1f2 Homestead
valuation w535.000 -T$
Signature of Auditor Data signed
2111
ASSESSED
—Vg
HOMESTEAD,
NO S6E
4IVN N4'lir '-�T—LA-:Kw
Qe— It
WE
Land not exceeding 1 (me) acre immediately
-W-mg
surrounding residential improvements.
Other land
v.
1 ,
(2)
m m
Total land (fine 1 plus fine 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile /Manufactured Home
Garage
(5)
Other improvements
(6)
N
ONE%
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 p1m line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARDIDEDUC'nOWALILOWANCE
20 _ Pay 20
Lesser of 1f2 Homestead
valuation w535.000 -T$
Signature of Auditor Data signed
STATE FORM 53569(R2i8-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE
thydnititrAW Oaputrattrop i a ro7u iMing 09 • • o' • • o )
•
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
-111causes 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.
•
PAR,-Ic PRO r RI I IN •0 RMAMTi O N
Taxpayer Name Property Address State Parcel Number Lent Description:
Jeffrey Ile 407 W CHESTNUT ST 26-13-19-202-000.151-005 OLD PLAN 49PT
FRANCISCO IN 47648 V
5
Complete and return to: fhI00]0V00B01m01 lrn QImmQVIMmti➢NI
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
•
INFORMATION
Owner I First Middle Last
6-41%f -
Madng Address(number and street city,state and ZIP code) Same as property address
I/O — c Gti as ><nin-F po Q:,(e -Era 4c s c L, IA/ q 26419
spouse First Middle Last
Ma'Srg Address(nimbi and street,city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivels Crenate State ID Number(last 5 digits) sue Other(please spady in Part 4 below)
PAR a€ERI IION ..
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 1 Signature Data
Q03 allnEUERIO,INFORMATION •