HomeMy WebLinkAboutHomestead_Pruitt SIAM FORM'!( ,RU -O l IAL'SBRLA FORM 1 S-tA
.Arrrlwtn BTRRE INviltDof Alvc4:srs.9• PREATInm BY ME DEPART-NEVI fir MAL COlctMNGT FP:1CCE lt'H.IQYAI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple are limited to orw homesead sandard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ea 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 eligiNe to receive the
benefit and to provide additional identifying informma!n nec.sary to allow county government to better monitor homestead
filings.This information will he kept confidential and can only be acccswd by authorised county official..The Department of
Local Government Finance will use this information to create toils that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Pruitt, Mary Lou
Box 284
Haubstadt IN 47639
3106
Mary Lou Pruitt
Box 284 State Parcel Number Leaal Description
Haubstadt IN 47639-0284
I III I I I I I I III 26-19-31-303-000.322-009 013-00322-00 ORIGINAL PLAN 293 PT/294
In urR nu tt u u un nu u r t r PT
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
MANY kdv Plyv1TT
kg Address(number and street.city,state,and ZIP code) ® Same as property address
PO BOX HAUBSTfA OT z1V )17d 39
Spouse First 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 Pan 4 below)
sve
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 Data
( /
PART 4:ADDITIONAL INFORMATION
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
'o State Form 5473 (112/5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM
Hc10
YEAR
RTIUK9, STATEMENT el I
I (We) / C,114that on.th -IS day of March, 19_
I (We) occupied as our principal a e of residence the following described real property for whicha- HomesteadP.r perty'Taz Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract N ` -
❑ Have 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 RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
I number
Legal description
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to froduce income. degEnbe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
re of of claimant
�.ereby certify the above statements are true, correct and complete.
'
Address (number and street, city, state. ZIP code)
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
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
Ir 19 Pay 19
Lesser of 112 Homestead y
Valuation or 52,000
Signature of Auditor
D e signed ^r
.D BOO