Homestead_KirkpatrickCLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 IRS 1 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
L;I:KIIF-,IL;ATIJ 05 tl-'R
TATFMlzNT--','%
I (We) Litify that
ch the 1 st day of March 20
I (We) occupied as our principal place of residence the following described . real property for hick a Homestead Prop",rfy-Tax.0 "eiis �h�e�4�by'claimm-ed'
/- C'C�ok' -
❑ 1 (We) owned ❑ Are buying under contract ry
Wave 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.
NTRACT!RECORDED- I.
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
:Z;; � R74N ,:- .a-IPROPERT,Y.DESCRIP.TION- lam• - ,
County
Township
Taxing district (city, town, township)
els—oollo-co
P
Leg
escrip ion
Is the propeb:�o�n
.1 prop. ny ❑ Mobile Home (I.C. 61.1-7)
If any portion of the residential structure or the land not exceeding OrUl) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the prop" utilized to produce income.
a'4
A -�VALUj�J.
W, t%a ;�:t P R 0 P E N IN'OT H E W 6 dU N T I
FitYbWNE107BY C&IRLA T
County
Township
County Township
hereby certify the above statements are true, correct and complete.
S nay f clal an
dress number ands city state, ZIP code) (7—.
144>U Ll I W1 9
U A
0
M-Wi-�Fll -MS-S1E--S-R0R, USE,
—TRUE-TAX �i
MUAL6E!
;HOMESTEAD��
% ffl-,NONmRESIDENTIAi2
__,'ONILV
Q
--AT 100% OF;rwi
ej,VALUE!5�
A -�VALUj�J.
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
TY,
Residential improvements
Garage
(5)
X-1— - le-
Other improvements
(6)
W
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD . DEDUCTION' ALLOWANCE IP- gftZt Je!
20 _ Pay 20
Lesser of 1y2 Homestead
Valuation or $6.000
Signature of Auditor Date signed
U
STATE FORM 51%(83/610) - IALARTI"FORM TS-IA
APPROVED BY STATE BO■RD OF ACCOUNTS,200 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE.IC 6-1.1-134.1 -
GibsonCounty Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 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
F I E E D benefit and to provide additional identifying into motion recesses o allow count' government to better monitor homestead
filings.ands 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
APR 211 Taxpayer Name . Location Address
C. ,N Kirkpatrick, Brian K/Shari L
114 S JEREMY LN
GIBSON COUNTY AUDITOR HAUBSTADT IN 47639
2353
Brian K Kirkpatrick i l l]HIIIummmm III U01111I1 F111111H1111i ll/111111111 III 011111[milmiii ill
114 S Jeremy Lane
HAUBSTADT IN 47639-8160
ItIIIIPIII'I'III"'III 'IIrIF'II'lllll'll"'I""1'I1Ill1l1tllll1 State Parcel Number Legal Description
26-18-36-403-000.710-009 EST HGTS 3RD ADD 214
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.
- 1 . . PART 2: TAXPAYER INFORMATION
-Q First Middle Last
•
EJQ.1a"1 k. Li2tc k .
Mailing Address(number and street.city,state,and ZIP code) I, ie as property address
11`-� S SEQFM La'ie o
_Last
SYNa Itl b 1' ' ^ck
.„ Mailing Address(Tumbiand street,city.state,aria ZlP code) . `_—
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