Homestead_Bajzath SINE FORM!)Mnr'I,WI TAGSnrr}H10.VSIA '
.Vnttn'En BY STATE 004110 M AMUNIS.ryIr, PAEYAInm OT TIr DEPMTSElr Of LOCAL G OVER,NMMT FINANCE MVI.I-L'4.1
Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual 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.Ilomesteal 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 receve the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings this information will he kepi confidential and can only Nt accessed by authorized county officials.The Depannxnt of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
— Taxpayer Name Property Address
Bajzath, John/Carol J
— RI Box 44 C
Oakland City IN 47660
4297
John/Carol J Bajzath
10546E 50 S State Parcel Number Legal Description
Oakland City IN 47660-8630
1ajujjutjtjjutjjnjj ut�u�nlitntlltlltntlndrlludintl 26-13-12-300-0 00011.350-006 003-01350-00 PT SW SW 1229.78 AC
� 1
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
SAN -- . /qJ z 7/
®tg Address(number and street,city,state,and ZIP code) _ -- --- -- U Same its prapertv adds s - — - -
•/0 5-go 1-.3-0 5a UTH 6,9 kfANo' a iy, 7,vd. /lc 7 ' 6 a
.
pouse First Middle Last
(4 RD L CFFR 4) 81J z n -77/
Mailing Address(Number and street,city,state,and ZIP code) (Same as property address
10.596 E So 5 (94g1-411/ ci j x/►> v 16‘o
Each undersigned certifies,under penalty of penury,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. .
Own I)I S' nature Date
da vap
e/ 4 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R215-92)
uu
INSTRUCTIONS: See reverse side for filing instructions.
F.ID I YEAR
HC10
AP `'
I (We) _ c hat on the 1 st day of March, 19
occupied as our pririci I pia a of residence the fol w g described real property for which a Hom tea Property Tax Credit is hereby claimed:
1 (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 _
It buying on contract, Fee Simple owner's name - -
Recorder's office where contract is recorded
Record number Page
-
el PROPERTY DESCRIPTION -
County -
Township
Taxing nct (city, town, township) _.
Parcel number
v3
Leg
scription
�a- - .�
It any portion of the residential structure or the land
of 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.
(2)
- a- sao -
Total land (line I plus line 2)
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County
Township
County
Township
.eby certify the above statements are true, correct and complete.
Sig r dal ant
Address (number and street. very, state, ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL -
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line I plus line 2)
3
l
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7) '
Total value (line 3 pfis line 7)
(g)
-
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
'Verifying action - Signature at Auditor
Date signed
19_Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
S