Homestead_Johnson MATE FOI I!Mt.O:Fi.tO TRELCIIIIA F0/0 173-1A
AFrK(EO by!T•It.BOARD Or MVN.'FS.`o. FtfXTIDEP RV 1FIF DEPARTAEVrtf LORAL GOVERNMENT FNANCE M•-I.1-L4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndividuaLs and married couple are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ner for homestead fraud.Ilomestead 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 receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
lilinps.This information will be kept confidential and on only he accessed by nuthnrized county officials.the Depanntent of
Local Government Finance still use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Johnson, Jerry W/Lucinda A
RI Box 282
Oakland City IN 47660
5036
Jerry W/Lucinda A Johnson
694SSR57
Oakland City IN 47660 State Parcel Number Legal Description
26-14-18-103-000.459-006 FARMER&SON TRACT 11/10 PT
\x/ C-1
PART 2:TAXPAYER INFORMATION
Owner I First ' l Middle LL Last
�) err /n 'N n >°- .j0 Y1 SO it
—
•tg Address(numbdand sweet,city,state,and ZIP code) 1) aSnme as property oddress
kg s. s���e_ �-7 d4 >� ►ia � , 4 X�g10 s
Spouse - First Middle Last
Lac d vi • Johnson
Mailing Address(Number and street,city,state.and ZIP code) -Same as property address
5• S-Fa+t s"7 l�Ae (l~ nd C , f .�'N /J/7{/#��
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
•
da °. CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side for tiling instructions.
I (We)
FORM
on
0) OC61]led as our pnn al.place of residenn� the following described real prou�ry for which a Homestead Properyyax 'E+edii�is�%'reby`�a(rrfed
U t
�, i (We) owned Are buying under contract Gin �n:J COi It."T'% r•' '71
❑ 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
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
• PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTION
CountyTownship
County
Tmvnship
Taxirg district (ary, town, township)
PaKel
number—
Legal descriptio
_-
Otherland
(2)
O
It any portion of the residential structure or the land not exceedir
i used to produce irloome, descri a the use land portion
of the properly utilized to produce income.
-
• PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Tmvnship
�eby certify the above statements are true, correct and complete.
Ignature o
aimant
Address ( numbber and sire (. ary. state. Zl(P code) �n
rC d
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Signature of Auditor
_-
Otherland
(2)
Total land (line t 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 ptrs line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE '
19_Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
S
Signature of Auditor
Date siti _ 3 _