Homestead_Johnson (2) MATE FORM 5371.07:/Wit TREASURER FORM t-tA
APPROVED BY STATE'W ARD°.MIYO:VTS.1%M PREATUDWD BY nu-OPPARINCENT OF LOCAL CAS'tRYMFXT FINANCE MH.1-r-El
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 dedtraion becomes
more beneficial,there is more incentive than net for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
ask-
FIFA 1344-2009 requires axpalers who receive the homestead standard deduction to verily that they are eligible to rneue the
benefit and to provide additional identifying information necessary to allow county government to barer monitor homestead
filings.This information will be kryv confdemial and can only he accessed by authorized couny officials.lie Department of
Local Government Finance aill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Johnson, Kevin L/Melynda S b
POBox 125
Oakland City IN 47660
4335
Kevin L/Melynda S Johnson
10607E 100 S State Parcel Number Legal Description
Oakland City IN 47660-8655
26-13-13-300-001.395-006 003-01395-00 PT SW 13291.576 AC
1r1u11u t�t��tn��n��u t�n�u��n t�r�u� r��nr�tn�r �nl 0
X
PART 2: TAXPAYER INFORMATION
Owner 1 first 1 Middle Last
HEuIN GE J01-()v5 0 Ai
1 e Address(number and street,city,state,and ZIP code) 'Same as property address
10607 E /0oc) 041r(AND c /tt ) -tv 1-776619
Spouse First Middle Last
Nrc VA/04 5u g 0oHN5o4/
Mailing Address(Number and street,city,sate,and ZIP code) Same as property address
/0 60 7 E /oo s // m v
orcn, 6 c /-r- Lt ,-z Ay 11710
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
•
5T` CLAIM FOR HOMESTEAD PROPERTY TAX
j CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5-92)
s
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
CERTIFICATION STATEMENT
"(We)cupied certify n e s y o arch, 19
our ptincip ace of residence the following described real property for which a Homestead Propert 4&K Crgitj,5�y�,�eby claimed:
❑ I (We) owned ❑ Are buying under contract - J ((YY ' ZZSS [[n�������
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buyingf der a it
CONTRACT RECORDED rco �_ .. r •� �• `�•
It buying on contract, Fee Simple owners name
Recordels office where contract is recorded
Record number
Page
PROPERTY DESCRIPTIO
Coun
Township
Taxing dis[ri t (d o
township)
Legal de
If any portion of the residential structure or the land not exceeding one (1) a re that immediately surrounds that structure is used to produce income, describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County -
Township
County
Township
Sig of claimant
ereby certify the above statements are true, correct and complete.
ddr (number and street, city, state. ZIP code)
RlP1 160 X (5>6 1) t)
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE -
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4) '
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
$
luation or $2,000
Sig �f Auditor
Date signed
to -a000
11�