HomeMy WebLinkAboutHomestead_LewisCLAIM FOR HOMESTEAD PROPERTY TAX FORM F YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R5110 -01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
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I (we) V71 L)Cly? F�B 0 6 ZUUZ
certify that on the 1st day of March, 20
I (We) occ ied as our prin4al pla I residence thegollowing described real property for which a K9-mestead Pro de'reby claimed:
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❑ 1 (We) owned 0 bu g under contract . J�
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❑ Are V 0
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gwave 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`RECORDW
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROP. ERT;Y--15E2iCRfP.TldN
20 _Pay 2O_
Township
Taxing district
Pa 1
,5 nrber
Legal aNZcription,
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Is the'prop" in question:
lotc 0 Real property ❑Mobile Home (LC. 61.1-7)
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 Portion
of the property utilized to produce income.
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01—
20 _Pay 2O_
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.. \,20n
lure or c ant
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11111111VIess (number and street, city, state. ZIP code) U C/
Ek= 405 S. weci( (47639
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20 _Pay 2O_
Lesser of 112 Homestead
) �NON= RIESIDENTIAL -i�
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Date siff"vd,
1(
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
' j,.
g
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
X
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 Assessor
Date signed
complete.
I
Verifying action - Signature of Auditor
Date signed
Wqr,--e,� -;
STANDARDMEDUCTIONALLOWANCE fje?�P
20 _Pay 2O_
Lesser of 112 Homestead
Valuation or $6.000
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Signs We of Auditor
Date siff"vd,
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•• STATE FORM!AAA IIC/',Pal rlEASUUER Po0.V:AAA
.APPROVED BY SIAM IDOVIDOf MYYUI.\T3.-ZAN PAF.RAIBED AV nn DEPA ATWYT(w LOCAL CAWERACAOt MTA\CE ICVI.I-r4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple.are limited to one homestead uandard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e'er for homestead fraud.I lomestead fmud causes higher tax bills for all:therefore.
Ili HEA 134-1-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reecho the
benefit and to provide additional identifying information nears ry to allow county government to better monitor homestead
filings.This information will he kepi confidential and can only be accessed by authorised county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Lewis, Gregory M/JackieT
R2 Box 341
Hauhstadt IN 47639
3325
Gregory M Lewis
409 S West ST State Parcel Number Legal Description
HAUBSTADT IN 47639-8155
1r1rr 11r trltllrttrlltlr�tt�ttlrtr tllllll It 1t1t11rtritlttrt11r1 26-22-01-200-000.236-009 013-00236-00 PTEFR 1-a-11 .70 AC
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 1 First Middle Last
Cre.jorci M - (,eAwis .
�ng Address(number and street.city,state,and ZIP code) 1, Same as property address
Spouse First Middle Last
Taak '
:c T. Lewis
Mailing Address(Number and street,city,state.and ZIP code) [a Same as propene address
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 Signn ,/,, Date