Homestead_Hartley (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614-03) T'1 F '•T ' z� `("`�
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions-
-
ERTIFICATIONSTATEMENTr . +u.M`S -��: iy;L_
I (We)
certify That on the 1st day of March, 20
(We) occupied as our principal place of residence the fol ng described real property for which a Homestead Property Tax Credit is hereby claimed:
(�e) owned ❑ Are buying under contract U 8bC';
1kHave 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 wntract.
re. ONTR/iCT'RECORDED e'�
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
=` �'` t�`.:: �.: �- r��` �". �'° ��" %! �` �'' �i` c�`' xelrr''� S' �• 7 ,- rc.:PROPERT,Y:�ESCRIPTION`�`< t=' 'a.'.c,?� zv��_. rs.,7-- �"?�`"�'��. {o-
County
Township
Taxin Ls =ty town. rownship)
Parcel number 010-W139,-
Legal description Is the properlyy5Auestion:
J , J Real property ❑ Mobile Home (I.C. 6-1.1-7).
If any portion of the residential structure or the Land not exceeding one (1) acre that immediatety surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
PROP,ERTY:OWNED,BY CLAIM/ 1Ni. IN�OTFIERCOUNTIES 'f�u';r'^a_ti�;"?�;��g' -;�X�
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
ig t e of imant
Address (number and street, wry; stare, ZIP code)
Lyl t sn, �..
-� ASSESSOR USE ONLYTr
</L Y
iTRUEzTAX +-.��
ASSESSED VALUE'
y.
+yHOMESTE�ADye�
: T +t"' NON= RESIDENTIAL„�c.
:. '* ._. rs..- s�`.: T_ S:` x.-,:. 7iti.' r°.f!,',`s�„z+{'uVALUEY`.�
-..AT
100 %'OF'TTYa
t�.` as VALUEnSs '*- .r..`".r�VALUE.`i3''.�.
Land not exceeding 1 (one) acre immediately
_
-',-
surrounding residential improvements-
2re��`r��W�
Other land
(2)y"
°"
Total land (line 1 plus line 2)
(3)
Dwelling
(q)
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
5
ar+ z
Other improvements
(6)?!-
F iy T
1
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
�M�V ri,. ??c STANDARUAEDUCTION'ALLOWANCE� ,.3a3;,�+ik.5.�i _.wat3�i�";�.e,��ii>��n
20 _ Pay 20
Lesser of 1/2 Homestead 5
Valuation or 535.000
Signature of Auditor Date signed
stATE nMM!3,ta fWel TREASURER FORM 73-1A
TEMRfw'ED BY Sl•TE BOARD Of ArEntt.T'-b+ ,tnstUBEm BY nil DEPAATTEI TOr LOCAL GO5ER.4MFA'r FINANCE IC i-I.1-rat
Gibson County Auditor N Main
10'I IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple.are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than net for homestead fraud.I Iomestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2000 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
tiling.ibis information will be kept confidential and can only be accessed by authnrieed county officials.The Depannent 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
Hartley, Robin Ray
k
Somerville IN 47683
8419
Robin Ray Hartley
P O Box 321 State Parcel Number Leaal Description
SOMERVILLE IN 47683-0321
lrlrrllrrrirlirrlttlrTtlltll Ilt ttlrltrr llr r1r 1r rr11rr11t1 26-20-02-204-000.138-003 020-00138-00 MOORES ADD 10/11
• PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
/7a
0S/N AL, �
_— •ng Address(number and street.city,state,and ZIP code) - - - Same as propcity. addrESS— --- - -- - -- -
13gb9a/ 5-oft-of20,{Xh'c r76 t3
/\\/
Spouse • Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
— —^ - — sat
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
S(use
Signature Date Telephone 1/
PART 4:ADDITIONAL INFORMATION
•