Homestead_OnealCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Fonn 5473 (R6 17-07)
Prescribed by the Department at Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
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JUN 1 8 2009
I (We) U certityM NjtCM fllB^PfAMVtbi0_
(We) occupied our principal ace of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
_1 (We) owned El Are buying under contact
�
1 J 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 • -D
If buying on contract, Fee Simple ownels name
Recorder's office where contract is recorded Record number Page
County Township Toxin district (city, t , 1ownship)
Parcel number (� {� Legal description the Probert�y�0 n:
pct L - Czl_)— l \ '- [ l� 3 — �� . l 13 a '• (��1 ei t-J nwl property ❑ Mobile Home (7C 61.1 -7)
If 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 Witted to produce income.
ASSESSOR USE ONLY
TRUE TAX VALUE
ASSESSED VALUE
HOMESTEAD
NON-RESIDENTIA L.
AT 100% OF TTV .1
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Motile / Manufactured Home
Garage
(5)
a: ,.:- .;:' ".%'i•..''_: =_' -
Y t>
T:
Other improvements
(6)
- r -..:C ;-.-•i ...,, ,,'
Total improvements (fine 4 through tine 6)
(7)
Total value (line 3 pia fine 7)
(8)
1 hereby certify the above is We, coned, and
Signature ofAssessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day. year)
STANDARD
20 _ pay 20 _ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation $
Of 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor
Date (month, day, year)
/signed
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• SIAFE f(MI!IN OC If+nl IREINIEAfORM SI•
AflflED BY!tAlE B 1 DrwAnlaIYla._IN P ENCIUD WBY nil DEPARIARYr(4 LOCAL GOVERNMENT FQ:ANCEMFI.1-14.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple,are limned to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ever for homestead fraud.Ilomesteal fraud causes higher tax bills for all:therefore.
HEA 1344--2009 requires taxpayers who re homestead the hoestead standard deduction to verify that they are eligible to receive the
�A benefit and to provide additional identifying information RYrsary to allow counts'government to better monitor homestead
filings.This information will he kept conlidouial and ran only he accessed by authorized county officials.The Ikpannrm 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
Fritz, Jerry Alan
k3
Oakland City IN 47(,00,lj
8620 I n lllj!/
Alvin Brent Oneal
5001 S Lincoln St State Parcel Number Legal Description
OAKLAND CITY IN 47660-7659
1111t111r11Ellttrllttllllrltttl111fttItIuIt1ttil IIIEIr11 26-20-14-103-000.032-002 015-00032-00 PT NW14-3-9.66AC
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PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
/C)/4 &en f D*e4
ne iii/Addd�ress((number and street, state,and ZIP code) /� n D Same as property address - — - -— — -- .— -
(0770 S- Piurs1or1 S+ 04 lc 144c (41*� , T-"J y/ 6a6Oo
-
Spouse First Middle Last
Mailing Address(Number and street,city,stale,and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sus
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
Spouse Signature Date Telephone
( l
( )
�// PART 4:ADDITIONAL INFORMATION
4'rsx 4 T4X,,///n S(/E/er Gat(, 0Lure /, /}-IVti1 lgrrA* OW e& ( ,4 deann1 f'6cup iS CO?.�re c 7C
6PSG S. Qia,stcn n-- 75 b Aare /rs;tile.