HomeMy WebLinkAboutHomestead_Heltsley�� CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
•- . CREDIT /STANDARD DEDUCTION
State Form 5473 (R817 -07)
•° �.,• � Prescribed by the Department of Local Government Finance F
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INSTRUCTIONS: See reverse side for filing instructions. _
I (We) hQj4A1J-01j certify-1 at onn IIW,X"y of March, 20
I (We) occupied as o principal place of residence the following d ribed real property for which a Homestead'Properfy Tao C�m9
i¢reby claimed:
I (We) awned ❑ A buying under contract (,lBSON Y C6311 Fes"'
Am
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.
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
County I Township
Taring district (city, town,
Record number I Page
pc —f 1 _O1 �30I � _ I�egal� pYpn I'' q I Is the property Real property ❑ Mobile Home (IC 6- r.1 -7)
If any portion of the residential structure or the land not exceeding
of the property utilized to produce inwrA_ �
immediately surrounds that structure is used to produce income, describe the use and portion
_ pay 20 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 112 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
m
Hoestead Valuation 5
Of 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor Date signed (month, day, year)
a r
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Land not exceeding 1 (one) acre immediately
- -
surrounding residential improvements.
(1)
\ ..
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually
Dwelling
(4)
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
I (6)
-�`
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
_ pay 20 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 112 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
m
Hoestead Valuation 5
Of 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor Date signed (month, day, year)
a r
STATE FORM 53569(5313-10) TREASURER FORM iSIA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1.22-8.1
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
flhauses 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.
PARTI PROPERTY$INFORMATION
Taxpayer Name Property Address State Parcel Number Leal Description:
Ryan T Heltsley 104 N VINE ST 26-19-31-301-000.283-009 ORIGINAL PLAN 113/114
HAUBSTADT IN 47639
Complete and return to: I®IIDO]ODODOO llDUfflDI®®mR�Um iI i1
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 LL
PART?:TAXPAI'ERINFOR�(:4TION .
Owner 1 First Middle - Last
R-14s-ar. -i VON- 0 e t -\-sl el
Mailing Address(number and streets city,state and ZIP code)
1 \ E✓ poverty$anm as Poty address
lo`% p3 0 ine St- \\Ck ..b si-o.-61.k. I IQ 42(03 1
Middle _ - Last
Mailing Address(number and street city,state and ZIP code) Sane as property address
Social Security Nurrter(last 5 digits) Drivers License/State ID Number(last 5 digits) sae Other(please specify in Part 4 below)
= 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 INFOR--AT-ON
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