Homestead_HessCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5.473 (R2 15-92)
INSTRUCTIONS: See. reverse side for tiling instructions.
FORM YEAR
HC10 R 3
i F 1E
t 1 i
4
V
CE TIFICATION STAT If
�M/E�/NT
(We) `-'— nify that on the 1st day of March, 19_
1 (We) occupie our principal place of residence the following des rib d real property for which a Ho stead Prope T/ /Credit' I er /.I claimed:
❑ I (We) owned E) Are buying under contract �,4ghSON COUNTY AUDITOR
❑ Have a beneficial interest in the entity that is liable for the properly taxes on the property and that own a property or is buying under a contract.
CONTRACT RECORDED
It buying on conuacf. Fee Simple owners name
'
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taring district (city, to
shi )
rcel r
% = o Y0
Legal description
S
If any portion of the residential structure or the land not exceedin
the property utilized to produce income.
one (1) acre that immediately su rids Mt structure is u to prod income, describe the use and portion of
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
I County
Township
ereby certify the above statements are true, correct
S f Caiman
and complete.
ess (number and street, city, state, ZIP code) a� s
rd
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
d not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Assesor -
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead
Valu on or $2,000
S
-
Si
re of Autlitor
Date si /
V
STiE FOSH!!wll:/.n,l TFFASUJIA FO0.43IA
.VFMNEt BY STULBtIBOrXMcV]Tib.v PFrsNarr.aY nIE OEPA0.neT(XLOCAL OATItNWAl FB:ASCE le u.DAI
Gibson County Auditor
- 101 N IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
zlAain
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard de duction.As the receipt of this deduction becomes
more beneficial.there is more incentive than es er for homestead fraud Homestead fraud causes higher tat bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verily that they are eligible to receve the
benefit and to provide additional identifying informanon necessary to allow county government to better monitor homestead
filings.This information will he kepi ennlidensial and can nnly be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county otl ciaLs eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Hess,Jerome H/Elizabeth A
109 Ben
Ilaubstadt IN 47639-8120
2707
Jerome H Hess
109 Ben St State Parcel Number Legal Description
HAUBSTADT IN 47639-8120
�t� r��rI u'nnl'rrr iii rllurlllrtrrr 111 26-\8-3§.402-000.488-009 013-00488-00 WESTHGTS 16/15 PT
nIln rlt 11r u I I
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 First Middle Last
Ter era ter, a .-3 4eSgr
IVAddress(number and street,city,slate,and ZIP code) ❑ Same ns property address
PD eox a16 l-laubs4c.dA- tM 0639
Spouse First Middle Last
E t zoA, 1, /inn Hess
Mailing Address(Number and street,city,stale,and"LIP code) Same as properly address
°o (30J Q) 1.. 0.,..A05 - N 47 C., 39
PART 3:CERTIFICATION �f�-^- - ---��" _. — .... —
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
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