HomeMy WebLinkAboutHomestead_Church STATE FORM!3 t'IR'I rYI WARIER PJRV}IA
APrROvED BY MATE.BOARD Of MSTLNT'.9• PRr.WRIBmaY Mr DEPMMEYr(F LOCAL rlwzLNsuTT mascin-1.1_rl
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and tarried 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 1344-7009 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Church, Obed Stanley/Judith K
R2 Box 40
Oakland City IN 47660
5602 0�
Obed S Church
12128E Hickory Lane State Parcel Number Legal Description
OAKLAND CITY IN 47660-8115
26-14-19-203-000.078-006 WATT ADD SEC A 7 PT NE 19 2 8.333 AC
to ntIP II nt I I a I I lu I I I I lu I I I I l I rIs II trI t It II
C-1
X
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
06 ED 4 a/LEti CE-1 u/CGN
�tg Addrlsl(numberr and street,city,state,and ZIP code) -- - -SOme its properry address "" - '- - -' -
� 2 / Z 8 G . Nio aY f4-'g OTh<-MNO O1V 4 L XJ 7(Q 4
Spouse First Middle Last
�)uA�iN A--t/ �/, C-�uw.ck
Mailing Address(Number and sweet,city,state,and ZIP code) Sane as property address
f2IZ.8 �• fluzoRy L44') 6041C AJO 611„DO cj%b,v
PART 3:CERTIFICATION
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
•
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDITISTANDARD DEDUCTION HC10
State Form 5M (R5/ 10-01)
Prescribed by the Department of Locall Giniemment Finance
INSTRUCTIONS., See reverse side for riling instructions.
!qERTIFICATION STk7MEn.! 'y
I (We) Ay certify that on the logy of March. 20
1 (We pied as our principal place of re /
oc Pencete following desc�bediear� �pe�omestead Property'Ta, Credit I here6y of 'eK.h.:
P1 '(Wecuowined El Are buying t ct
-�--i
ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prope orJ3
H 0�.'-Wmg r a cont'�ra'ct.
------ ..... NTRACT:REC0RDED
If buying on contract, Fee Simple owners name
Recorders offics where contract is recorded Rec,:,rd number Page
- ASSESSORIUSE ON
14�
County
I hereby certify the above statements am true, correct and complete.
Ti:wniship
I
7 - di wriship)
I rm;;�
Parcel number
60 3-oco-79-cO
�100WOFiT-W
L70 Or
-A
is the praperty, in qw6tion:
[;KReal property C) Mobile Home (I.C. 8-1. 1-7).
If my portion of the residential structure or the land not exceeding me (1) acre that immediately surmunds that structure is used to produce lm:ome. desadbe the use and portion
of the property ulifted to prod"
income. -7
C& - /�/'z
— 40e). eo;:5 -
- ASSESSORIUSE ON
County Tmnship
County Tmnship
I hereby certify the above statements am true, correct and complete.
Sign Of claimant.
/,/,a, 04Z4.11,4
,ALdress (number and street, city state, ZIP code) V
- ASSESSORIUSE ON
Wik S—eeD —VALEE—
"Al
Pomawzb
00-4-ym
�Idnwirq
'U
�01 -A-
VALUg 1
�100WOFiT-W
AV
� M% E�.
Land not exceeding 1 (one) acre immediately
qg
WR 54011=0- �`a
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
ResidenUal improvements
Garage
(5)
D�
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Yerifying action - Signaiture of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or $6,000
Date signed