HomeMy WebLinkAboutHomestead_Riley STATE FIRM 55569(R!SLOT TBEASL'RQ FORM tSIA
APPROVED BY STATE BOW°Cr ACCOUNT 5.: S PRrscaem BY ME DEPARTMENT Cr LOCAL GOVERNMENT FINANCE IC AI.1 TNT 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 causes 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 indentifying 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.
PART 1: PROPERTY INFORMATION
Property Address(number and street,ci ,state,and ZIP code)
//_'S 3 .S AzeL a �G
State Parcel Number 2013� I E Lcfo -/,Z-/f Ao3_oO.3. OGo2-O21 GIBSON COUNTY OCT 1
AUDITOR
PART 2:TAXPAYER INFORMATION
Owner I First Middle ^ Last
Vi9a#12 to
Mailing Address(number and street,city,state,and ZIP code) n Same as pro •address
Spouse First Middle Last
Mail Address(Number and street,city,state,and ZIP code) 0 Same as prope address
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 n Date
INSTRUCTIONS
M of
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R6 / 4-03)
Presaibed by the DepaM1ment of Local Gavemment Financa
INSTRUCTIONS: See reverse side /w (lirg instnxtions.
M
H 10
MAR 3 1 2006
� �e) � � certjLylCJbN (;vU(; tl YAl1DITOR 20_
I(We) occupi d as our principal place o( r' nce the followin described e V
g property for which a Homesteatl Property Tac re it ishereby daimed:
❑ I(We) owned ❑ Are buying under cont2cl '
' Have a benefidal inieresl in ihe entlry that is liable for the property taxes on the property and that owns the property or is buying under a conUacl.
If buy'ug on conuad. Fee Simple owners name
Recordefs olfice where conirad is recorAed
County
Tuvnship
�( �� C�VWJ�"CJV '��
If any portion o( Ne residenUal sWCWre w the land nol
of ihe properry Wlized to produce income.
County
one (7) acre that
I hereby certify the above statements are true, corted and complete.
�ddress (number arM street, c(ry, s(ate, ZlP code) �
Record number
fown,
Pa9e
Is tAe properry in question:
�Real properry ❑ Mobile Hwno (I.C. 61.7-))
surrounds �hat ure is used W produce inoome, desriibe �he use antl portion
County
��'�"�"��'� s�'T"- -� t � �� 1' - �t''��. ��e`. ''�"TRUE.TAX 'b � ASSESSED VALUE � HOMESTEAD» �`'� NON-RESIDENTIAL��'' �
3-z sASSESSOR USE ONLY. - � � zv. *�t �.e �"-, h �'y�"
�����.� yya. �". _ ���u�#a, � V/LLUE� AT100%OFPiT7V� �,�;VALUE�� ��'��y';��VALUE�_�ti:,�
land not exceeding 1(one) aae immediatety ' =%,4.�a�,�"�'-y�z ,�r ,"�rY���
suvounding residential improvements. ( � :,'� �,,,'� 'V r�,,.,,�,������Yy:
.4 hx w� �'
t.�3-,11F'" T�CY; y
Other land (Z) �:.'�2 �ca^
�� -�s ��
Total land (line 1 plus line 2) (3�
�� d��r,� �- � e,s x-a-�.�� f.s*�
Dwelling (4) :s�,t�u�'s_ER��`'-���
�Reskentlel improvemenLS or Mnuairy ���
Assassed Mobile / Manufactured Home Garage (5� ';�;��. ""c'�' 's" ' «� :
��'� .:��������,
P (s) ��` '��_
Otherim rovements ��
� �,�^��
Tdal improvements (line 4 through line 6) ��)
Tdal value (line 3 plts line � (g�
I hereby certify fhe above is We, corred, and Sienature otnssessor Date signea
compiete.
Vaifyi(g action - SignaWre ofAuditor Date signed
"'T''4�� �: " ��"'"c'�-1�="`-t'�'�,�I�'s�.�STANDARU:DEDUCTIONALLOWANCEt ,�^'�:"f "='"�z'"'��`-+
_ 3:.,
5 -s.az ��-�r. __�:.:R'� 'u!ubs t+.. a1h..H`,'�'iak`.uen�-S£i!.,3�4,'�+3I5:.��_-�`�+i.�+¢xe".:-
20_Pay20_
Lesser of 1l2 Homes;ead
vauaLOn a S35.OW S
Sgnalure oflwditw � Date signed
_ . _ �1 1T l7' �--. � __