Homestead_Lloyd (3)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION .
l a
State Form 5473 (R2 15-92)
1Blfi
INSTRUCTIONS: See reverse side for filing instructions.
FORM
C]0
r_
f,3
CERTIFICATION STATEMENT n
//
,(We) 0 4 1st da of Marc , 19
I (We) as our p e the (lowing described real property for which a Homestead Pr'o`�edy�T all rd:
esidencontract
of oe y AUDITOR
0
)upied
Arelace
e owned
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)
Parcel number
Legal description
nk C3
If any portion of the residen I structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion of
the property utilized to produce income.
�G- /3- /9- Ooa - a�-v.lea- &-ya-r
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Signature of aimant
ereby certify the above statements are true, correct and complete.
I�
icJ
A dress (number and street, city, state, ZIP code)
LQ O
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON- RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
Verifying action - Signature of Auditor Date signed
*. STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead S _
Valuation or $2,000
Signature of Auditor
Date signed
—� —c) _.
STATE FORM 53569(R3/8-10) TREASURER FORM TS.1 A
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1"2-s.I
, 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
+:auses 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.
7.4TARTI:.PROPERTY INFORMATION , •
Taxpayer Name Prooerh Address Slate Parcel Number Leeal Description:
Vance/Lori Lloyd 601 N MAIN ST 26-13-19-202-000.168-005 F&MC I
FRANCISCO IN 47649
Complete and return to: IuLtlitltljlpilulizu°bJ 1 0�1�i 1141117tI JLLOl1�LpRJLL1 L1W
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION- t=
Owner I First Middle Last
U7k nrle . IA lot ICI
Maavg Address(number and street,city,state and ZIP cede)
Same as property address
P�
Pnx ,Q03 Ron' \scO I RI 4'l U 41
�oouse First Middle 1. last
t�/l_Yl 1 -
Magirg Address(comber and street,city,state and ZIP code) Same as property address
PO 6X203 Flrarc i o " I 0 111104q
' ;- -
-:� "*fir-=--rT- �, �5-f-icy... ,._!_
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 Date
aataid
;4._1-: .PART_4;.ADDITIONALa1NFORMATION a : :: :r'v y1y. � `;.;>sj
F
,
• DEC 212012
C \3
r;IRSON COUNTY AUDITOR