Homestead_Smith (2) coal[ORM 53W.ile ••I lWaBLER FOAM 75-1A
Gibason County Auditor ArPRtwED BY A`.aE°°"R"Ot ACCOUNTS_F../ PVYAIBFD BY i11r DEPARIS`rr(f LOCAL CRH'_LNMCA'r FINANCE Mal.l-L-rl
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
. PRINCETON IN 47670 Individuals and married couplet are limited to one homestead standard deduction.As the 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.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction In verily that they arc eligible to recebe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will be kept confdential and can only he accessed by authorized county officials.The Depannlent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Smith, Marietta Life Est Eta!
S
Oakland City IN 47660 -
4696
Marietta Smith Life Est Etal
10286 E SR 64 State Parcel Number Legal Description
Oakland City IN 47660
26-13-23-200-000.910-006 003-00910-00 PT E NE 23-2-9 77 AC
D-6 C-1
V
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
•
• - I e— Ia
Ig Address(number and street,city,state,and ZIP code) • Same as property addles- -
--- — -
/ Da8(0 E. St. R4 . ) N j-�7t( 0
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) []Same as property address
Social Security Number(tact 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
slaw
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 Telephone
ttci -E
Spouse Signature Date Telephone r l
PART 4:
4ADDITIONAL INFORMATION
- •
•
CLAIM FOR HOMESTEAD PROPERTY TAX
a'= CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
reu
INSTRUCTIONS: See reverse side for filing instructions.
occupied as our principal place of residence the following do9cribed real property for which a
(We) owned ❑ Are buying under contract
rl�!w - "i'llp, i-1 J
19
claimed:
❑ 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
It buying on contract, Fee Simple owner's name -
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTION
County
Township
Taxing dist ,ct city, n, township) o - -
Parcel number
Lega description r�,y,' y^
C)
/ / C_
It any portion of the residential structure 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.
(2)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
eby certify the above statements are true, correct and complete.
Signature of claimant _
Address (number and street, city, 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)
S
Otherland
(2)
Signature of Auditor
Total land (line 1 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 pUs line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
ing action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 —Pay 19_
Lesser of 1/2 Homestead
S
Valuation or S2,000
Signature of Auditor
Date signed –
(T/