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t CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
` State Forth 5473 (R5110 -01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FORM �j� YEAR
HC70 1, \
FILED
I (We) _ ( J CV 'Y— 3611 \,�t� certify that on
(We) occupied as our principal place of residence the following described real property for which a Homestead Prop ert ❑ f (We) awned ❑ Are buying under contract GIBSON C
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.
NTRACTRECORDEDU`;; iczr`'' 1..- 3w,:a"'"= u'Yg }::a,zT'.s —`,�
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
P,ERTY:DESCRIP,TION��
Caen
Township
Taain d trio (city own,
of claimant
dress (number and street, city, state, ZIP code)
o. 2 11C 0"a Z 14 (
?
Iship
Date signed
Parcel number Lega s 'pUo Is the property question:
3 � /' /t
Real property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that' mrTredia�ly surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. GG�;??CX�I [[ / /Jf
"�� �.� ?`3n= "s/rk-'",'a- 4. PROP, ERTYOWNEDBYiCL ''AIMANT_.INrOTk1ER' COUNTIES' ?'r°.,:rk`i,.Lul ? f,- °4.?"..u:'+i[.F
County Township
County Township
I hereby certify the above statements are true, correct and complete. -.Sisinaturq
of claimant
dress (number and street, city, state, ZIP code)
o. 2 11C 0"a Z 14 (
W"��ASS S O yUS ONLY-
iTRUE TA7(
ASSESSEDVALUE
"HOMESTEAD'
NON= RESIDENTL4L jam"
;g..Aiyr -„t
�A.yVALUE,v,,rtt
ATa700%.OFT7VVALUEar�.VALUE��`
Date signed
Land not exceeding 1 (one) acre immediately
MUM-- AI,tir'�'
surrounding residential improvements.
Other land
2
( )
:;- '`r--:`
_ - -�-
-.4ro�y}sr
Total land (line I plus line 2)
(3)
Dwelling
(4),�':'��
�
Residential improvements
Garage
(5)»;y'Ek
Other improvements
(6)
iW. 777 $a
Trial improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(6)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
'-
Verifying action - Signature of Auditor
Date signed
;- >tTf�'-rw- STANDARDAEDUCTION AL'LOWANCE.r;f"',p;;` y iy;,'.'•"" u '!u'ai`.''.SLm?.e�•ti+?Lai,'�'.s �-k
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or $6,000
$
Signature of Auditor
Date signed
0.
STATE FORM 535.6O(RJI&10) MEASLIER FORM TS-IA
• APPROVED DV STATE BOARD Or ACCOUNTS.2C04 PRESCRIBED BT THE DFPARTME\T OF LOCAL GOVERA'MLNT FINANCE IC 6-1.1-22-8.1
Gibson County 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 lax bills for all;therefore,
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
-
filings.This 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 1:'PROPER"1'1' INFOILN7A"1'10\
- Taxpayer Name . Location Address
_ Topper, Chad W/Staci M
- - - 115S2ND AVE
y � I i_ E�- — - HAUBSTADT IN 47639 _
Chad W Topper
2744 - II I II III -
II�L�IHml III Iuullll_I OI IIIIIWh o II III II_ II_III�I�IDI IIII I�DIIDiI_II I I�III
1uS2nd APR 5 2011
Haubstadt IN 47639
c.'3.r+ v V State Parcel Number Legal Description
- 26-19-31-304000.20&009/PT SW 31 3 10 .229 AC
GIBSON,CPUNTY AUDITOR
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.
O'. t First Middle - Last
014 111Q PM..... " ' I9PPi%
Mailing Address(number and street,city,state,and ZIP code) • ❑ Same as property address
P.O. Box 112. 115 S. Sera Jl Ave "bs ) 1V N7&39
Spouse First Middle T Last
51aci (T1.chtIIC - . "wen
—Mzilinr Addiess(Number and sneer eitr to and ZIP code)' ---`-'--.—E Same u propeityaddras - - -
P.o, g IIZ 115 S. Stanek R■frc #kt9bs ,f11, tPV '476239
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 Si t - Date
PART 4: ADDITIONAL INFORMATION -