HomeMy WebLinkAboutHomestead_EubanksCLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
Stete Fam 5473 (R6 / 4-03)
Pre�aibed by Ne Department W Lxal Govemmerrt Finance
INSTRUCTIONS: See rarerse side /or filirg instn/ctions.
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Y
FORM
HC10
YEAR
I(N/e) certify thal on t��1�1 d9y � 13sccp. 20_
I(VJe) occupied as our pri 'pal place oi residence Ihe following described real property for which a Homestead Property� -Ty�c� ,Credil is hereby daimed:
� I(VJe) owned ❑!ve buying under contract �. O'�a�y ,Q �
� Have a beneficial interest in the entity that is Iiabie for ihe property taxes on ihe property and that owns ihe pr�pFrC�hlig�i�r�g4nde���cnntracl.
�UR
If buyirg om m�traq, Fee Simple ownets name
where contraU is remrdetl
unty / Tnvnship
����
u 1 nupqer � L
7
�ny poAim of the residentlal sWCtura w the land not
t�he nVmperty utilizeE to produce income.
/ [.GT�C:C.I' �
one (1j acre that
Rewrd number � Page
Ils the prope i ueslion:
rRea� D�operry ❑ Mobiie Hwno (I.C. 6f.1-n
surtounds Nat sLUCWre is used lo produce incwne, describe Ne use and portion
Counly Tavrns�ip County .
I hereby certify the above statements are We, cortect and complete. �� Si9natu�t claimar
(number arM streel, cdy, state, ZIP cade) _
`�-��,�.e;"..` .��y vj`��;�}.n����.,.�`STANDARU;DEOUCTIONALCOWANCE »�,�:���.;"--'"��",3 `" ;.�`:=-�"�;�3i�.'y�'i�s�.-_--,',�?
20 _ Pay 20 _
Lesser W 1/2 Homestead
vauanon or 535.000
5
SynaWraofPLditw " Datesigned
STAiE FOIC\I S}5691�8-10)
AP^1tOVED B\' STATE BOMD OF ACCOUYfS. 3009
TRFASIIRER FORM TSIA
PRESCRIBEDBYTHE�EPARTME\TOFLOCALGOVER.\NE�TFIlVMCEICbI.I �?-B-I
, / � , , / . 1 1 � , 1 � , �
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more iuceotive than ever for homestead fraud. Homestead fraud
�uses higher ta� bills for all; therefore, HEA 1344-2009 requires tatpayers who recei��e the homestead
sT"bdard deduction to ��erify� that they are eligible to receive the benefit and to pro��ide additional identifying
informatioo necessar�� to allow couut�� go��ernment to better monitor homestead filings. This information
will be kept coufidential and can ouly be accessed by authorized county officials. The Departmgnt of Local
Government Finance ��•ill use this iuformation to create tools that ��•ill help count�� officials eliminate
Ta:oa.er �ame
Andrea �f Afiller
Compfete and return to:
Umaf
�
Procert�' Addms
il7 N HART ST
PRINCETON IN a7670
homestead fraud.
Statt Parttl \umber
26- I 2-07-102-002392-028
Le;al Dncrintian:
OLD PIAN I 10 PT
i�iio��c��o����m���m�o��!�i000m�
CIBSON COUNTT AUDITOR 101 N�I�+.IN PRINCETON L\ 47670
First
An�iro �, m;�r ila
sveel dry. state aiW ZIP coae) r"
� L�
�. 11
5 dlglts) Onve(s LimiwJSlale ID Nurtbcr (WZt 5 tllglt5)
First
Maiting PDOress (mirtEa antl streel tlry. state ana ZIP mae)
waaie
Same as properry a0eress
AIiEGIe
Sarte as P�P�Y aCtlress
a ee�mv�
SodalSemriryNurtEerfbst501glts) DriversLicensHStatelDthrtGerfWStstllplts) srae Ol�cld�uspedtyinPanabelow)
m
Each undersigned certifies, under penalry of perjury, that the above and foregoing information is We and correct and ihat he or she is eligible to receive i
homestead standard deductlon on this property. Each undersigned also understands that, by Gaiming addifional homestead deductions unlawfully, he w
she may be liable ta back taues and substantial finandal penalGes.
Qmer 1 SiguWt!
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Da�e
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Tdep�me
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