Homestead_MoweryCLAIM FOR HOMESTEAD PROPERTY TAX
s CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 t 5 -92)
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INSTRUCTIONS: See reverse side for filing instructions.
{g� YEAR
NOV 2 0 1997
' CERTIFICATION STATEMENT
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(We) certify 05a -- fflAsf :dAybf' ar d9_
occu red as our principal place o residerice the folio described real properly for v U It a Homestead Property Tax Credit is hereby claimed:
(We) owned ❑ Are buying under contract
❑ 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 owner's name 7 -
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
PROPERTY DESCRIPTION -
County Township
County
Taxing district (dry, town, township)
P Lcel ber Legal description
ignature of alai ant
If any portion of the residential structure or the land not exceedi
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.
Date si netl
Otherland
(2)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County
Township
County
Township
-eby certify the above statements are true, correct and complete.
ignature of alai ant
Address (number and street, city, state. ZIP code)
�I � o� i 7 X74,4
STANDARD DEDUCTION ALLOWANCE
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Signature of Auditor
Date si netl
Otherland
(2)
Total land (line I 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)
(S)
I hereby certify the above is true, correct. and
complete.
Signature of Assessor
Date signed
verifying action - Signature of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 112 Homestead
$
Valuation or $2.000
Signature of Auditor
Date si netl
STATE FORM 51569(RIB-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1.22-8 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 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.
' ""- i :' PARTI-"PROPERTY'INFORMATION -- ' " •
Tatum er Name rroeerty Address Slate Parcel Number Leeal Description:
Kevin L/Tracy Mowery 412 DIVISION ST 26-13-I8-404-000.299-005 PT SE 18-2-9 1.00 AC
FRANCISCO IN 47649 C-i
Complete and return to: I9!II!6! 19 PARIBOMIIIIMEIC1E.ln !! IE! C
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
I"" :';f - •.. , : .PART 2:•TAXPAYER INFORMATION w;l 7& fc i . I
Owner I First Middle last
KVIn Let Iv �� 1owe'i
Mailing Address(number and street.oty,state and ZIP code)
Sane as property address
D1 151 �t • crC.nCtSCa _I-N-1 LI ill
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Spouse First Middle Last
acs, m0 it,P•'`1,
Mading Address(number and street,cip,state and ZIP code)
l property same as openy address - -
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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 Signature Date
FILE
NOV '5 2012
O1enner
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