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Homestead_Jackson / STALL IORM!5 a,X tw i TgfAW RFA FORM iSIA le*rIMPORTANT,NOTICETO OFPARTHEYT OF LOCAL COVE ANNIENT(NANCE IC PROPERTY OWNERS zA Gibson County Auditor 101 N Main 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 ma for homestead fraud homestead fraud causes higher in bills for all;therefore. ® HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to receue the benefit and to pros'ide additional identifying information necessary to allow county government to better monitor homestead filintt.This information will he kept cent:dential and can only be accessed by authorized county officials.The Department of Local Government Finance will use this information to create tools that will h:Ip county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Jackson, Kenneth R/Shiela R 2219S 1200 E Oakland City IN 47660 5616 Kenneth R/Shiela R Jackson 2219 S 1200E State Parcel Number . Legal Description Oakland City IN 47660-8124 It�nilntitllutilnliutlu1rru 11n1r1rhnituilltlnnitll 26-14-19-300-000.879-006 003-00879-00 PTN SW 19-2-8.918 AC X PART 2:TAXPAYER INFORMATION Owned First Middle Last r Ktyi x,,�-i-A To eks o %r 1•Ie Address(number and street,city,state,and ZIP code) - - - - -- - l yl Sam e its property address- -- - -— -- Spouse First Middle Last ;e.lG J 4cLr'o ,7 Mailing Address(Number and street,city,state,and ZIP code) • Same as property address Each undersigmed certifies,under penalty of perjury.that the above and foregoing information is use 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 ° CREDIT /STANDARD DEDUCTION State Form 5473 (132 / 592) INSTRUCTIONS: See reverse side for filing instructions. FORM YEAR HC10 I •ile)/ /X// / �l.J(.�d/`� �� certify that on the 1st day of March. 19_ occ ied as our principal place of residence the following cribed real property for which a Homestead Property Tax Credit is hereby claimed: r1 (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. NOV CONTRACT RECORDED I buying on contract. Fee Simple owner's name i/t'/ / -x•- -- Recorder's office where contract is recorded Record number Page PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES County Peby certify the above statements are true. correct and complete. Address (number and street. city. state. ZIP code) ASSESSOR USE ONLY PROPERTY DESCRIPTIO County Township Taxing distr' I (cit . r township) /� nu be, p, _ ©O Legal description 11 any portion of theee 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 - G - /�/ 9 -060 -• 979 -�� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES County Peby certify the above statements are true. correct and complete. Address (number and street. city. state. ZIP code) ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON - RESIDENTIAL VALUE VALUE VALUE VALUE Land not exceeding 1 (one) acre immediately surrounding residential improvements. I (1) Other land (2) Total land (line i plus line 2) (3) Dwelling (a) Residential improvements Garage (5) Other improvements (6) Total improvements (line 4 through line 6) I (7) Total value (line 3 pfrs line T) (g) I hereby certify the above is true, correct. and I Signature of Assessor I Date signed complete. Verify ng action - Signature of Auditor I Date signed STANDARD DEDUCTION ALLOWANCE 19_Pay 19_ . Lesser of 1/2 Homestead S Valuation or S2.000 Signature of Auditor - Date sig �_—