HomeMy WebLinkAboutHomestead_Clark SIAM FORM'!'MIR_I!"NI TALASUW1 FORM 79-IA
RmtIMPORTANT NOTICE TO HOMESTEAD PROPERTY ROWNERS '
Gibson County Auditor
101 N Main
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than net for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
• HEA 1344-2000 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information neasmry to allow county government to better monitor homestead
filings.This information will he kepi confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create twit that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Prnperty Address
Clark, David A/Faith K
501 N'Church
Ilaubstadt IN 47639-8116
2702
David A Clark
501 W Church State Parcel Number Legal Description
HAUBSTADT IN 47639-8116
itlttlltttltllttttlltlllttltllttttlltttlltllttll Ilrlttll 26-18-36-402-000.328-009 013-0032tw0WESTHGTS312PT
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.
PART 2: TAXPAYER INFORMATION
Owner I Last
First q Middle La
0 a Ult ti A C lark
ag Address(number and street,city,state,and ZIP code) la Same as property address
S 0 I L✓, Cliqrcl,
—
Spouse First Middle Last
Fea(-l1h K C141/c
Mailine Address(Number and street city,state,and ZDP code) E.Same as property address
-
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 elieible 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.
I Signature Date /(]
PART 4:ADDITIONAL INFORMATION
•
•
rt CLAIM FOR HOMESTEAD PROPERTY TAX EOR1ul EAR
CREDIT /STANDARD DEDUCTION Hc-" 1
S State Form 5473 (R4 / 8-00)
INSTRUCTIONS: See reverse side for filing instructions. " A�_"
`n'" "YC�EpFtIn] IICpA710Nr�5_,{T�}A.(T�E�MENT
I_(We) l D_ �� �� o U!6 C` x yL certify that on the 1st day of March, 20_
1 (We) occupied as our pnncibal place of residence the following described real property for which a Homestead Property Tax Credit ishereby claimed:
I (We) owned Cl Are buying under contract
Wave 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.
'`t'c-xGONT_RA_CgRECORID
E_D':
11 buying on contract Fee Simple owners name
Recorders office where contract is recorded , - Record number Page
' PR 'OPERT!Y�O,WNEDIBY;C�LAIh9AN1'
PRQPERTj'YfD_ ESCRIPR �TION a.•z'?4, -
County
Township Taxing dis ct (city, town, townshr
hereby certify the above statements are We, correct and complete.
Parcel number
Legal description.
ol3 � 0 0 8p
LUE_ 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 utilized to produce income. - -
' PR 'OPERT!Y�O,WNEDIBY;C�LAIh9AN1'
IN OTH CER OUNTIES �R5- 4��MD ,`�, 'c 'x'O.
County Township
County - Township
hereby certify the above statements are We, correct and complete.
Signatu of claimant
ress Inumbu and street city, state, ZIP code)
lv: ti� - 4Ss 76 q
c� [1NIW •rte, 7. '" -A
TFtUEvTAX t
ASSESSEDV ALUEancH�sOMESTEAD
-
- ••ate''
' +.T IG'�a iMDE.-�
Gk NON`RESIUENTIA
ITS-
'.s -'u+- �.- "'gU3'`''4
.r'�V- ALy,eU.E -.e� + :"
A•T:'160Yo�OF^. -.,.
LUE_ 7.,
sV.�- a ®.�=� ._
Land not exceeding 1 (one) acre immediately
1
O
1
1 "d
surrounding residential improvements.
Other land
(2)
- I7, Y'
-
zms"9-
s
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
-`, -.: ,
Other improvements
(6)
gsrtl
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
hereby certify the above is We, correct, and
Signature of /assessor
Date signed
complete.
Vert" action - Signature of Auditor
Date signed
DEDUCTION
ALLOWANCE ' g< W, °
_ ��x...�.,;��.�'�n
20_Pay 20_
Lesser of 12 Homestead
$
Valuation or $6,000
Signature ofAuditor
Date signed
1
1 "d