Homestead_Perry (2) SIAM FORM•!V+III'1% t TArASUIER r00.4 fStA
APPROVED DYsro1.MMPDIIF ACCOUNTS.:OW PITSRIamD BY Mr DfPARioE4rff LOCAL GO EtYNrwrmsANCE IC 6-I.1-24.1
'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 die 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.
lir HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recent the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will be kepi confidential and can only he accessed by authnrieed county officials.The Depannlent of
Local Government Finance Dill me this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Perry, Leon
Oaklan. fly IN 47660
4291
/ Leon Perry
/ 286 S 1050E State Parcel Number Lesal Description
OAKLAND CITY IN 47660-8623
IPI„II, ,IlllllrllPlllnrllrrirrllPrril lnrll,ILrflllll,llllll 26-13-12-300-000.263-006 003-00263-00 PT S SW 12-2-9 4.00 AC
C-1
• PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
gag Address(number and street.city,state,and ZIP code) - _- -- — -Same ns proper ewetness
Spouse First Middle Last
Mailing Address(Number and strtt4 city,state,and ZIP code) Same as propeny address
Social Security Number(last 5 digits) D,iscfs License/State ID Number (last 5 digits) Other(please specify.in Part 4 below)
- • son
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
unlawfidly,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature _� Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX �� FORM YEAR
CREDIT /STANDARD DEDUCTION Hc10
State Form 5473 (8614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See rnww sk.b for fi tp im6uc6cns. U N RED XA ON
I (we) 1 Kam/ rtify�iiaft�-tl-stday of March, 20
I (We) occupied as ur principal place of residence the owing described real property for which a om r t &914ffy claimed:
ibson Count ❑ 1 (We) owned ❑ Are buying under contract a y
Parcel s
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owol _ tract.
ONTRACT RECORDED.,- '',ie,'�•ceFn'-;"r�"°i' ='.'9
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
- �;ti1r': ''"' Fe+ s�', �-
��- 4E4,i5P,ROP,ERTYDESCRIP.TIONs7 ��.�3��;.�'�`;"f �?�- �;'�',,•��n`�`�?';- 9.�;f+' -*
un
Township
Taring district (city, town, to p)
Tmnship
I hereby certify the above statements are true, correct and complete.
O arnhjr
P
I n r
Legal description
Is the property m question:
eal property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential struchure or the
land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
-�.. , ice✓ �. -- r — +,t`e'". ;
3-
(2)
' ei",- n• %"x'^,'^Z'_`PROP.ERTY;OWNEDrBI! CLAIMANT ;INOTFiER'000NTIES;r,,.x:?,°-
�` x'?
County
Township
County
Tmnship
I hereby certify the above statements are true, correct and complete.
Signature of claimant
65 (number and street, city, slate, ZIP code)
65 c 766
rt �d-TRUEvTAX�
- R 1�CR 7AS.4ESSOR USE ONLY-
s
ASSESSED VALUE
`HOMESTEAD''
ANON- RESIDENTL4L.
�4'r...E
VALUE :
ATa100 %'OFr,�,TTV�Ao
VALUEj!a. 5''4
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
-�.. , ice✓ �. -- r — +,t`e'". ;
Other land
(2)
f s
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
4c) z��
IRW
'Residential Improvements or Annually
1
Assessed Mobile / Manullactured Home
Garage
(5)
Other improvements
(6)
an -
Total improvements (line 4 through line 6)
(T)
Trial value (line 3 plus line 7)
(6)
hereby certify the above is true, cored, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1t2 Homestead
valuation or MS.000
S
Date