Homestead_GrimwoodCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION Ct
State Form 5473 (R6 / 4-o3)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions. NOV 12 2004
I (We) A , / C" t i / / l a.4 L/YY /_(JlTO CS--'
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed
❑ I (We) owned ❑ Are buying under contract
' 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.
c:r_.. 2.�.. •.3a�e,'',�� -�a:.��isw ~x.i'2'sC0 NTRACT 'RECORDED'_'-- z.� -��'." u'�`. ;aag3•��%>�:�;:`���- �i
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
- - -- -• - —
- s'•,..� �ri.,s:.sc?';'`r..�.-- `vnu3. P.ROP.ERTY,OWNEDIBY CLAIMANT IN OTFIER'COUNTIES,�...sc
9;MA.>w„v,",.';'.P,1i0P,ERT,Y, 15ESCRIPTI6N.. r�- >riefx_?'F- ...'.•t�.�"i`ss --,ta `eT4F+i5`i,'
County
County Township
Township
Signature a clai I
Taxi district .ty, town, township)
AT.�100 % -0F "TTY
tVALUEt
«-!TT ..:
b:•VALUE
��e..*i s ..7a•a
Land not exceeding t (one) acre immediately
Q
Parcel number
/y/66-oo
ey pt�
h ty qu I
on:
Real pe ny El Mobile Home (LC. 61. f -n
If any portion of the
residential structure or Ne 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.
' ✓ :_
- - -- -• - —
- s'•,..� �ri.,s:.sc?';'`r..�.-- `vnu3. P.ROP.ERTY,OWNEDIBY CLAIMANT IN OTFIER'COUNTIES,�...sc
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature a clai I
�reu n m6eraM street city, stafp, ZIP code)
✓ { '�
AT.�100 % -0F "TTY
n F�sCk 0-
3n �=' "•6 ' #• ' -'t-"` -, ',,�^..•`,
USE ONLYij
iTRUE�TAX WG
ASSESSEDVALUE.;
HOMESTEADS'
NONRESIDENTIAL "
t .ASSESSOR
�•�� F.X wn}.�,..s aa.��,'�3
d•yALUE ,h
ul .
AT.�100 % -0F "TTY
tVALUEt
«-!TT ..:
b:•VALUE
��e..*i s ..7a•a
Land not exceeding t (one) acre immediately
t
e$k
r¢�"P'" r.;�.,� � G
surrounding residential improvements.
Other land
( 2 )
' ✓ :_
Tilly
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
,c
Residential improvements or AnnuaOy
.4$�aF^ .2.•�"��3 5ft'
Assessed Mobile / Manufactured Home
Garage
' I W t='"�as
Other improvements
(6)•,
�
? , . a; 1i
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
s'rr= STANDARD: DEDUCTIONALLOWANCE;, 4"*• isA,' "�"air`§reitira`?t�,°b,'';^`".-
20_ Pay 20_
Lesser of 112 Homestead S
valuation or E35.000
Signature of Auditor Date signed
STATE FORM 53569(R3/5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1--22-5.I
IMPORTANT NOTICE TOHOMESTEAD PROPERTY OWNERS* ;L
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
auction 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 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 filings. This information
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
;: "•3 PARTIT PROPERTY INFORMATION Iw % Fl 4 .-71‘73.,..!. ,.. : w<_ '
Taapaver Name Property Address State Parcel Number Leal Description:
Daniel R Grimwood 7048 S SR 57 26-20-15402-000.066-002 PT E SE 15-3-9.92 AC
OAKLAND CITY IN 47660
Complete and return to: Iu11II01I11111111110111101.111E111IHI III IUD III 11111111:11111111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
';,'ei' PART 2.'rTAXPAYERdNFORMATION.a:4.: +i P a;l 'a,a:' . , t.Flfr!✓•.
Owner 1 First Middle Last
ti
lJ� fi�ii✓ (9/-1 4
.•�ujO
Mailing d/s(nnnber
street,city,state and ZIP code)
p$ante as property address
Other(please specify in Part 4 below)
Spouse t/) First Middle Last
Mailing Address(number and 4��city,state ZIP code) I-1
ame as poverty address
L
: .> ""' ;tkw" 5cr�' _
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 1 Signa A,,, ;o Date 7 // Telephone
Spouse Signature Date Telephone
t
y ri '.. PART:4:AADDITIONAL;INFORMATION * a;:.-e- -R:; e z tNaar q';:•
/
1