Homestead_Clark •
%TanE 1011.I!Mt.(R2/5WI 1RLALIIt1R FORM iS1A
.ArFROVED BTxr11E MAROtp.MMIILNTA`lrr. PITSCREBW BY Mt bEPARTMEgTor LOCAL OOVE44MrK1 MB:ANCE IC t•1.1-_,.1
Gibson County Auditor
11 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N
PRINCETON IN 47670 Individual and married couples are limited to one homestead aundani deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than es er for homestead fraud.Ilomestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to recehe the
benefit and to provide additional identifying information necessary to allow county gmrmment to better monitor homestead
filings.This information will he kept conidemial and can only be accessed by authorind 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
Clark, Connie
R2 Box 13
Oakland City IN 47660
1917
Connie Clark
R 2 Box 13 State Parcel Number Legal Description
OAKLAND CITY IN 47660-8103
lrlttfIrrrirlitrt11tt11rrt1tt1tttr1111 ��IIII���II�IP�I:tr� 26-14-18-402-000.169-006 00000169-00 PT NE SE I&2-6.25 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
g .
• dLL
- • iF Addmss tnumbefand street.city,scare,and ZiP code)_ — _ _ _. _. __ri Same as property sits -_
/33 it Z. a vc sT 69,..4_4„ ,e6.4 at en 66O
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
slate
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 1 Signature �` Date
I
L
-CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R4 / 6-00)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
I (We) certify that on the 1st day of March, 20_
j(We pie as our principal place of residence the following described real property for which a Homestead edit ieg�n��Pb[imed:
We) o wned ❑ Are buying under contract ��--j�� ave a beneficial interest in the entity that ot liable for the property taxes on the property and that owns the property or is uyingTltiCfir ot.
'fi•??."- s>4_?7 a"Li� i r5 raASw�Lt�`+ita:
�� ��' t��'._' �.. �.'_ �, �,.,, s�a '� "�,�CONTRACTgR.ECORDED.��aun "sue 5,".,x {.- .��•-,u, .....'�ras-
If buying on contract Fee Simple owners name
GIBBON ter r ,r
Recorder's office where contract is recorded Record number Page
.r
EU TAX -«
VALUE
ER FDffC1 II�691MQ
County
County Torn '
Twvnship Taxing dis t ( ty, to ,township) '
I hereby certify the above statements are true, correct and complete.
Signature of claim t. �/,'
tic. u Le"
Legal description
If any portion of the residential structure m 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.
11)
.r
EU TAX -«
VALUE
Coun
Twvnship
County Torn '
�a ''*•.�"7.a. :'�`�+,- sS
I hereby certify the above statements are true, correct and complete.
Signature of claim t. �/,'
tic. u Le"
'•ess (number and street city, stale. ZIP code)
L_ 12 z t30 /3 La 76 6 d
J
- ASSESSOR USE.ONCY�r`/.�
EU TAX -«
VALUE
WSSESSED VALUE
$- %'OE4t..VALUE`
«HOMESTEAD
•` ., s ON N R 31DENTWL..
- s
VALUE
�a ''*•.�"7.a. :'�`�+,- sS
br
4 �:zF
,�AT.r100
}� �i}
b'' .
Land not exceeding 1 (one) acre immediately
11)
-
surroundingresidentialimprovements.
- ,.v•._sec �-.-
Other land- -
(2)
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
' A—stC
y- �J'�,r� .
'�� '.
Residential improvements
Garage
'a£
(5)
Y _ ]
Other improvements
(6)
s-:��, e
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action- Signature of Auditor
Date signed
Signature of Auditor
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation or $6,000