HomeMy WebLinkAboutHomestead_Clark (2) curt FORM3,"rJ r•1 TPLASULU FOAM 11A
nrrnED BY STATE BMRDOF!COMM a.yes PUS RInmD BY nit OrrARINI:D a Or LOLA1<AVEAYS:TNT FINANCE ur.-tl ra.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead uandanl deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ner for homestead fraud.Ilomestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayer who remise the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifvin_ information necessary to allow roomy government to better monitor homestead
filings.This information will he kept conlidentinl and can only be areensed 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Clark, William URose Anna
411 E Church SI'
Haubstadt IN 47639
8130
William L Clark
411E Church State Parcel Number Legal Description
HAUBSTADT IN 47639-8211
IIlIJlulItlIInt111111n11111111111.11111JL111111111LIJ1 26-19-31-101-000.644-009 013m644-00ELPERSNEUMAN 9
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
william lewis Clark
�ng Address(number and street.city,state,and ZIP code) _— — Snore as property oddrtss; - - — — — —_
Spouse First Middle Last
Rose Anna Clark
Mailing Address(Number and strtreel,city,state,and ZIP code) 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 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
PART 4: ADDITIONAL INFORMATION
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
t State Form 6473 (RS / 10-01)
rr M IF-
-Prescribed by the Department of Local Government Finance F"
INSTRUCTIONS: See reverse side for filing instructions.
IfR
_�CERTIF.I TION;STATEMENT- "'f:,' "s#y -- `.pia' - -i� ;"- __'- -_
I (We) E /✓/%f} �� ty that on e 1 ay of,f�erch 0
(We) occupied as our principal place of residence the following described real property for which a Hom ,'`f/°JVl b aimed:
❑ I (We) owned ❑ Are buying under contract GIBS0N OU Ty AUDITOR
0 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.
t3'E.itSR "' 'i4!- }Q".1+"— �bX -'•P _ :r _ -, r -s _'"6. »r..,rN.` .a.'dt:,, ._ .
ONTRACT :RECORDEO„�`'�.>fi,?3t'- 'i'•,.r'�r.,t - �:�'.p�te* -'yk
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
?rte'' v,° ��31��` PROPERTYOWNED; IiYCLAIAAANT;
aROPERTVY dESCRIP.TIONI+
County
To msNp
strict (dry, town, township)
A6 0j
dress (number and street, ' , state, ZIP code)
1l,,
ParcelnWnber /
L description Is the pmpertyi question:
3 `7L
Real property ❑ Mobile Homo (LC. 61. 1-7).
If any portion of me residential structure or the tend n exceeding one (1) acre that immediately surrounds that siructure Is used to produce income. describe the use and portion
of the property utilized to produce income.
NON- RESt�ENTIAL _
?rte'' v,° ��31��` PROPERTYOWNED; IiYCLAIAAANT;
IIJOTHER `COUNTIES;�r'��•�,.,7b- t,�;�� "` - ���
County Township
County Twwnship
hereby certify the above statements are true, coned and complete.
Si tore of ctaimant
dress (number and street, ' , state, ZIP code)
1l,,
Signature of Auditor
�tf -sr�
- TRU NC ,
ASSESSED VALl1E
bHOMESTEAD
NON- RESt�ENTIAL _
,""�'
• VALUE
SAT ,100 %OFTTV
VALUEb,-.
*?iVA�LUEH?`'
Land not exceeding 1 (one) acre immediately
;, ' - . I M IN `
#'
surrounding residential improvements.
r`= ,t
Other land
(2)
.-'
>r i51£
Total land (line 1 plus line 2)
(3)
- rA 92'-"s
«
Dwelling
(4)
&� ; .
°'°- '' "� ..
011-1111
Residential improvements
Garage
(6);..
ig
Other improvements
(6)
a
Trial improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(S)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verif ft action - Signature of Auditor
Date signed
_.4;_- 1 N r-- = -Wrig7 NO . i �'x STANCAR61DEDUCTION "AIIWWANCE«
20 _ Pay 20
Lesser of 1/2 Homestead
$
Valuation or $6,000
Signature of Auditor
Date signed