Homestead_Adler�w
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (1121 5-92)
INSTRUCTIONS: See reverse side for filing instructions.
i
HC10
JAN 0
G�rLna� 6K M,,,Ir-s
CERTIFICATION STATEMENT - AU L) I I VIR "
I (We) _ �{„YJy certify that oathe_tst day of March, 19
I (We) occupied as our ncipal place of residence the following described real property for which a Homestead Property: a`.x Credit`. herby claimed:
\�
[ X/ ' t niJe) owned ❑ Are buying under contract
r
�t 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
It buying on contract, Fee Simple owners name
Recorder's office where Contract is recorded Record number Page
°1 PROPERTY DESCRIPTION - -
County
Townshi
Taxing district (pry, town, to"shhiip.)r
Parcel number
Legal description 'a
' .' /�,`I
wYLS/`
Signature of Auditor
It any portion of the residential structure or the land not exceeding one (1) act at immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
- QI5 -0o OD? -C) 0
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
1 hereby certify the above statements are true, correct and complete.
Si ure of claimant
Signature of Auditor
�n`mber and street ary, state. 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)
Signature of Auditor
Date signed
-
Otherland
(2)
Total land (line 1 plus line Z)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
-
Other improvements
(6)
Total improvements (line 4 through line 6)
(T)
Total value (line 3 p)js line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
• �r
` STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 112 Homestead
Valuation or ,000
S
Signature of Auditor
Date signed
I fl
%DIEwO0..BY 515 IR_/4M1 1RFAAlaER it}IA
YPfPrw EB BY taATE BOARD nr∎MCNIt._nR PREYNBmaY mE DEPMMEYTOf!AR L CA\i44MPi FPIVCE M1.I.I-L4.1
Gibson County Auditor
I, 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 ea for homestead fraud.Homestead fraud cause higher tax bills for all;therefore.
HEA 1344-2009 requires tatpasers who receive the homestead standard deduction to verify that they are eligible to Teethe the
benefit and to provide additional identifvino information necessary to allow county government to better monitor homestead
tiling..This information will he kept conEdemint and can only he accessed by authorized county official.The Department of
Local Government Finance will use this information to create twla that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION .
Taxpayer Name Property Address
Adler, Kerry D
6889 S Division St
Oakland City IN 47660
8659
Kerry D Adler
6889 S Division ST
Oakland City IN 47660-7735 State Parcel Number Legal Description
III I I I I I I I I I I r#II I� 6-20-15-204-000.007-002 015-00007-00 PT SE NE 15-3-9 2.38 AC
ra t
t o rat t rat n rat rat rat ra t t
/-
APR 2 7 LOW
71/0 /6/(a-d.
_ •
P4 ti'3: TAXPAYER INFORMATION
Owner I First Middle Last
A CY' r A t
tg Address(number and street,city,state,and ZIP code) -- Uiame as property address- - -— -
•
6g89 5 Ditilston S Oakland czar _73 c766o
Spouse First Middle Last
Mailing Address(Number and street city,state.and ZIP code) ❑ Scene 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)
sex
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 eliuible 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 Sienauue Date
/
Spouse t Date Telephone r l
PART 4:ADDITIONAL INFORMATION •