Homestead_BassCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
j State Forth 5473 (Ra 1403)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions,
mTx,a�.:ma`;"' ..°a`'�"` .,p!,nsd- 't:-tF ERTIFICATION. STATEMENTrzr-;M, it41'r't` k".3•�, -.?.'
1 (We) certify Ll on the ��si3ay ofF7larch, 20
I (We) occupied as our pn place of residence the following described real property for which a Homestead P erty, U Credihis hereby claimed:
❑ I (We) owned ❑ Are buying under contract LUI1J
Have a beneficial interest in the entity that is liable for the property taxes on the property and that ow/ the property or is buying under contract.
V
,: SON C0 "y At niTC^
'RECORDED
, t. - -- -- "t?+OL
f buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
!` ..s •3� -
'tw-0.o Z`',.' —M- IP,ROP.ERTY,DESCRIPTION ° -« ? Y� �: :' `.., '' "'C#r? -i "
my
Irmnship
Township
Taring district ( ry, town hip)
P r /�,
-W
L al descri tion Q Q�
� 3-9 r 6 9-2;2
Is the pro rty'
,
question:
sal property ❑ Mobile Homo (I.C. &f. f -7) .
that If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds t cture is used to produce income, describe the use and portion
of the property utilized to produce income.
.z'�'`- 'a.'vz __, ,:PROPERTY;OWNED`;BY;CL'AIMANT;
IN6THER`COUNTIEB
County
Irmnship
County Township
hereby certify the above statements are true, correct and complete.
ur of c tmant ,
y
(number and street, dry, state, ZIP e)
3
""'• _ .-..
a ES50 � E, Og '',s
"TR EU TA)(
-
- ASSESSED.VALUE
'4AT
HOMESTEAD ^
eNON- RESIDENTU\L ittli
ti �
VALUEy .s
100 %OF�TTV
'VALUE ±ter'.
y VALUE eye,,. M
Land not exceeding 1 (one) acre immediately
7;''�,4n''T:
surrounding residential improvements.
1
Other land
(2I
t' -' -
`''' =*' _ ' . �-
Total land (line I plus line 2)
(3)
Dwelling
(4)
�f{��.; Al e''
_[r Y
M
Residential Improvements or Annually
i
Assessed Mobile I Manufactured Home
Garage
i
Other improvements
(6)f~.
4 R �
,z^
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, corned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Vouaaon or E35.000
of Auditor
5
1'`i li it `t. r e• 1
•
STATE FORM!1'In0 C turf 'MASUUD FORM TS-IA
.Arrrovro BY stATE BOARD OF AICYRi'TS.•% PPSS[TIBm BY Ott UEPARrx6:VTOF L ixtu GOVEV{MFNT Fa:ASCE ICLI.I-'.a1
Gibson County Auditor
-101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limbed to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than err for homestead fraud.I lomestead fraud causes higher tax bills for all:therefore.
0 IAE\ 1344-1009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receke 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 toDls that will help roomy officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taipaver Name Property Address
Bass, Harold R 572SrS
.40.9-4.Lincoln ST
Somerville IN 37'683✓
3214
Harold R Bass
5128 S Lincoln St State Parcel Number Legal Description
OAKLAND CITY IN 47660-7661
)Ilia llrttirlitttilrtlltt tit rrlrllIlill 11rr 1r11rr1r1rt 111 26-20-02-402-0 0.025-003 020-00025-00 PT SE 239.6992 AC
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
t PART 2: TAXPAYER INFORMATION .
Owner 1 First Middle Last
AROL/� k •• 3S
___5-u•Address.(eunber and sleet:gin•;stalc.-rnd ZlP code) _ __. . • . - -_n-Sumcas property address—ee.11 _-
O�
,5707S 3. LrncQLAiSr -(2 RI-AA/a C7y) /A/ 97640
Spouse First Middle Last
JANE / ft --, A..51/4_S
Mailing Address(Number and street,city,state,and ZIP code) ri Same as property address
S/a85'• Z.iAtCocX St OAKLAAID air/4.%76Mo No
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 1 Signature Date
•ocA%FO /AI <SorncRVIa-E. - •