Homestead_Jones" CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
1 16
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
YEAR
A CERTIFICATION STATEMENT
I (We) tJ[./ certify that on the fat day of March, 19_
1 (We) occupielk as our principal place of residence a following described real property for which a Homestead Property Tax Credit is hereby claimed:
V'I (We) owned E) Are buying under contract - 4
i
Have a beneficial interest in the entity that is liable for the property taxes on the property and owns'the property or is buying under a contract.
n a
Iv 4ti V�q 1
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
:
-OCT z ass
Recorders office where contract is recorded r Record number
Page
PROPERTY DESCRIPTIOWSSOt�r.�.'..
County
Township T "ct Idly. t :, towns p) ' r
Pa number — Legal descripti on
If any potion of the resider sWCture or Ne IarM not ezceeding one (1) are drat immediately surrounds that structure is used to produce income, describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES -
County
Township
County
Township
ereby certify the above statements are true, correct and complete.
Signature of clai t
Address (number and street, city, state, ZIP code)
r e P.d 8 a3 rJau b5fa& �i A45 9'
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 112 Homestead
S
Valuation or 52,000
Signature of Auditor
Date signed
R1ntt FORM:Wee de/W'1 IREYNeuA POLY TS-1A
Ar1Rtn'EO 9T.I CIE Ik1 OOf nalMNIS.!MN PRESAIBEUI RV 1111-DEPARTW.YT IF IRMAI OVErNMFT FINANCE IC VI.I_J.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndiviJuaLs and married couples are limited to one homestead sandad deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ester for homestead fraud_Homestead fraud causes higher In bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recent the
benefit and to provide•additional identifying infunnatwn necessary to allow county government to better monitor homestead
filing..This information will he kept confidential and can only he accessed by authorized county officials.The Ikpanment of
Local Government Finance will use this information to create tools thai will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Properly Address
_ Jones, Melissa D
204 S 3rd AVE
Haubstadt IN 47639
3127
Melissa D Jones
204 S 3rd Ave State Parcel Number Legal Description
Haubstadt IN 47639
26-19-31-304-000.105-009 013-00105-00 E PARK ADD 424/425
__ ._—_ ___ ._ — _ _ _ - ------ _. __ __ _
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
me\.s5� wR Jcsl e_s
g Address(number and street,city,stare,and ZIP code) Same as property address
as 5. 3-L /iJe_, * s-1-t+-*- to L- Kt-yi
Spouse First Middle Last
Mailing Address(Number and street,city,sate.and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Drivers License/Sate ID Number (last 5 digits) 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
•