Homestead_Eberharde� CLAIM FOR HOMESTEAD PROPERTY TAX .
` CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 15-92)
VVVrrr777 INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
"
CERTAICATION S TEMENT
APR a
I (We) LAJA certify that on the 1st day -of March,.19
o upied as our principal place of residence the following described real property for which a Homestead operty Tax Gredii is hereby:claimed:
L�
l(We)owned . ❑ Are buying under contract %� -
Y property property P P�yVri Y 9
❑ Have a beneficial interest in the emit that is liable for the taxes on the and that owns t e ro ert or is bu in under a contract.
CONTRACT RECORDED -- --
If buying on contract. Fee Simple owner's name --
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION - -
Cc t
Township
Taxing district ( n, townshi
&eby certify the above statements are true, correct and complete.
Signatur (Gairrynt
number
Legal description
Parcel
Other land
It any portion of the residential structure or the land not exceeding one (1) acre that immetliatety surrou tls [hat structure is used to produce income, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
&eby certify the above statements are true, correct and complete.
Signatur (Gairrynt
Address (number and street,ary state, I code)
301 5. / W,
ri
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Signature of Auditor
Date signed
- -
Other land
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
,
Garage
(5)
Other improvements
(6)
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
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
- - STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
5
Signature of Auditor
Date signed
STATE FORM 53569(R31-10) a TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1 22-8.1
IMPORTANT NOTICE TO HOMESTEAD`PROPERTY.OWNERS
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 ever for homestead fraud. Homestead fraud
•uses 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.
• - •PART1-i PROPERTI' INFORMATION /1/ 1
Taxpayer Name Property Address State Parcel Number Lesat Description:
Ronald E/Vonda K Eberhard 301 S MAIN ST 26-19-31-303-000.008-009 ORIGINAL PLAN 317/318
Jr. HAUBSTADT IN 47639
Complete and return to: Igl1IIfIMINf171fI1F111110I1110mmmm1171ElIDEm®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 IL WI
PART 2: TAXPAYER INFORMATION `I
Owner t Arst riddle Last
'Ro1lr /d Cd tim.cL- ack R Rd. tk
r
Mailing Address(number and street.city.state and ZIP code)
f pe Sarre as rty address
30/ $ MMn 5-' UAIAIos-6d--, _ l� q7° q1
.
V DIV6xr r First /al c Middle. . Last
Mailing Address(minter and street,city,state and ZIP code) [Xi Same as property address
301 S Mwi 51- s�d-t- all 4-4-(0,3 F
PART 3: CERTIFICATION-
Easci 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.
Purer t Signature Date
• _' PART 4: ADDITIONA NFORMIATION
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