Homestead_Clark (2) •
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SIVE FORM.!R.IR'lf.B1 Ilt SULL3 FORM 7S-IA
nrrROVEO BY Srxl[anMIDOW Mn i,15.2Br, PLISIUBWD BY TIM DEPARTMENT OF LOCAL cOV_RXMt T ra:x'eE M 64.14:al
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 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 1343-2009 requires taapa■ers who receive the homestead standard deduction to verify that they are eligible to incise the
benefit and to ['wide additional identifying information necesarn to allow county government to better monitor homestead
filings.This information will be kept confidential and can only he accessed by authorized county officials.The Depanntent 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, Gary L Sr .
R2 Box fI n_
Oakland City IN 47660 U' W
5413 IIL
Gary L Clark Sr Sr. 13 I I 6,
R2 Box 6 State Parcel Number Leval Description 1 1
Oakland City IN 47660-8102
It�ll��ttt�t��ttt��tr��tt t�t t�t ttr���� �� ���L�rt� 26-14-18-402-000.306-006 0013-00306-00 PT NE SE 18-2-8.35 AC
PART 2:TAXPAYER INFORMATION
Owner I �7 First Middle /� / Last
(� �tiv y i e °& C-� hevYAi
•tg Address(number undftu/get,city,state,and ZIP code) — — – - — - —.0 Same as property iddress - ----—. _ _ _
7_ // //r- Y /1 1/1/1/ el /
Spouse First Middle Last
iii 72/17A
—
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 Pan 4 below)
sate
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 Signatury� Date
7
e%
x 4 CLAIM FOR HOMESTEAD PROPERTY TAX FORM
l• CREDIT /STANDARD. DEDUCTION HC10
„ � State Form 5473 (R215 -92)
0 reu
INSTRUCTIONS: See reverse side for filing instructions. V
^� �,
_ 'CERTIFICATION STATEMENT juli
YEAR
3
I(We) r ly/l ,l.(_ Y.�-� --� �_IJ1 -(9DC %i .(�/C certify thatAW 11 Mof_March,l�
Lye ccupied as our print I place of residence the following cl - dbed real property for which a Homestead Property Tax Credit is hereby claimed:
❑ Are buying under contract a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propertyAL)OPT(�R eracontract.
It buying on contract, Fee Simple owner's name -
Recorder's office where contract is recorded Record number Page
- -
- PROPERTY DESCRIPTION
County -
Township
Taxing district (ary. town, township)
Parcel number
Legal description
.1. 3 e
It any portion of the residential structure or the land not exceeding one (t) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
to - -/� �
Dot = CY.C�• �D �- LY� - ,
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County Township County Township
Sjreby certify the above statements are true, correct and complete. Signature of claimant
® ess (number and street. dry, stare. 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)
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 pins line/)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
ying action - Signature of Auditor
Date signed
19_Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
Auditor
STANDARD
111