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Homestead_GreenwellCLAIM FOR HOMESTEAD PROPERTY TAX CREDIT/STANDARD DEDUCTION State Form 5473 (R614-03) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse side for filing instructions. FORM YEAR HC10 I (We) ) certify that on the 1st day of March, 20 I (We) occupied a our principal place of resid ce e ollo g described real property for which omestead Property Tax Credit is hereby claimed: ❑ 1 (We) owned ❑ Are buying under contract 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.'RECORDED .'� Y`jv `•" �r3a'z +'-' Fnxs':�sza If buying on contract, Fee Simple owners name Recorders office where contract is recorded Record number Page {aw' -.. -ice-_ - - 'X4"'- nN.f'� `��a✓Lq ,e -.,.,. _ £l„N_ -. P,ROP,ERTI'.DESCRIPTION� County Township T g dis 'ct (city, to , to i ) P -ro Parcel number y Le al descri tion 9 P Is the property in estfon: eal property ❑ Mobile Home (I.C. 6-1.1 -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 potion of the property utilized to produce income. - ASSESSOR USE ONLY- t Y"�y;� +'S' zr9gVAI.l1E,i"%*t„. County Township County Township I hereby certify the above statements are true, correct and complete. Signature of claimant Address (number and street, city, state, ZIP code) - - ASSESSOR USE ONLY- t Y"�y;� +'S' zr9gVAI.l1E,i"%*t„. TRUETAX�� ASSESSEDYALUE _AT 100�e.OF_TTV HOMESTEPJ .VALUEF�`3VALUE"j .ANON= RESIDENTIAL Land not exceeding 1 (one) acre immediately surrounding residential improvements O Other land (2) - r Total land (line 1 plus line 2) (3) Dwelling (4)%t�- may. -'��' �•� � —t�'�T Residential improvements or Annualty£zae;+1 `— Assessed Motile I Manufactured Home Garage (5) . az f Other improvements (6) Total improvements (line 4 through line 6) (7) Total value (line 3 plus line 7) (0) I hereby certify the above is true, correct, and Signature of Assessor Date signed complete. Verifying action - Signature of Auditor Date signed 20 _ Pay 20 Lesser of 1/2 Homestead Valuation or $35.000 $ Signature of Auditor - Dale signed STATE FU¢Y 53569 On/LAO) T4FASll36lt I01111SIA •IMNVIL ell 3I Alt WAN)Ut Alt WST>DPI nttvot OY 3 in IRY.LC I UG\I lY LLC'AL W V[XAARYT,II.oC'A 1e anti53.I 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 causes 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. PART I: PROPERTY INFORMATION 26-18-36403-000.011-009 \ H 108 S Damosa Dr. \ Haubstadt 47639 • • PART 2:TAXPAYER INFORMATION Owner I First Middle Last Julius Eugene Greenwell Mailing Address(number and street city.state,and ZIP code) © Same as property address 108 S Damosa Dr. Haubstadt, IN 47639 IPSocial Spouse First Middle Last Joy Rachelle Greenwell Mailing Address(Number and street city,state,and ZIP code) ®Same as property address 108 S Damosa Dr. Haubstadt, IN 47639 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 ®� • INSTRUCTIONS