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CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
,i State Form 5473 (R6 14-03)
Prescribed by the Department of Local Government Finano_
INSTRUCTIONS: See reverse side for filing instructions.
I (We)�i���cl� % of rte tst'day of at 20
(We) occup ed as our principal place of residence the following described real property for which a Homestead Property Tax Credit is h reb claimed:
.�J J.LI
❑ I (We) owned ;@- rco act
r
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propert�orl.ls bluyder a contract
If buying on contract, Fee Simple owner's name
Recordees office where contract is recorded
Y AUDITOR
Record number I Page
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F'��.�-���.n,�-'�t�?£:- -¢.�� `kPROP,ERTY: OWNEDFBYCLAIMANT:INiOTHER' COUNTIES, c'. �+ „`�?s`ir`.'�^`.�_;k;?�`.., -:.
County Township
Court
Township
S lure of claims
Taxing district (city, town, township)
VALUE
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Pap�e(rtypper 0. ^ _
(J9M 0000,
' .,VALUE
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/ der
Sg2e property in question:
(� Real property ❑ Mobile Homo ( /.C. 6- 1.1 -7) .
N any portion of the residential sbudure or th4drpption not exceeding one (1) acre
of the property utilized to produce income.
tQ rounds that structure is used to produce income, describe the use and potion
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F'��.�-���.n,�-'�t�?£:- -¢.�� `kPROP,ERTY: OWNEDFBYCLAIMANT:INiOTHER' COUNTIES, c'. �+ „`�?s`ir`.'�^`.�_;k;?�`.., -:.
County Township
County Township
I hereby certify the above statements are true, correct and complete.
S lure of claims
IP code) d (gad ttyseZ /
y'ifyf LyLY �`TS"R6 ...
h"'ASSESSORIUSE ONLY` -
= +al`s
r aTRUE TAX r
iS
ASSESSEDVALUE+HOMESTEADy'
Y
• NON = RESIDENTIAL • -`.
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,
,e- emu:
VALUE
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- AT 100 /e OFTTV
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' .,VALUE
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VALUE'S” =
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Land not exceeding 1 (one) acre immediately
(1)c'•+r'
surrounding residential improvements.
-s'ryr
Other land
O 2
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
w �'
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
tlw- Y `
Other improvements
(6)
O�%31 31
Total improvements (line 4 through line 6)
(T)
Trial value (line 3 plus line 7)
(g)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
J v
20 _ Pay 20 _
Lesser of 112 Homestead
Valuation or 535.000
Signature of
Date signed ' O
iT
STATE FORM 53569(R3(5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-e.l
rt Il aifro veivemT4IC�EEO+�HOIVIES+T�E�AD7PROPER�TiY�O PTE
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
reduction becomes 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 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.
- . PARTE: PROP R V INFORMATIO .
Tasnacer Name Property Address State Parcel Number Legal Description:
5044 S WASHINGTON ST
Rex Oneal 26-20-02-201-000.027-003 MILLERS ADD 40/41/42/43/44/4 /46
OAKLAND CITY IN 47660
C07p lete o: t , _ � � 4
iffl[i[t[m[1[[[[[[3[uu3m[nim[m[m[[111[m[m[[[1[ru11u[i
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
Owner 1 .First Middle Last
11iCkarc4 c5mlll hart
Mailing Address(number and street,city,state and ZIP code) Same as property address
Spouse First Middle Last
Mailing Address(nunber and street,city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number(last 5 digits) State Other(Please specify in Part 4 below)
. • PART&CERTIFICATION`" . - 'i.
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 1 signature Date
Date Telephone
( )
7 PART�ADDITIONALINFORMATION i' "'J _ - "' -`E I
c ii
• JAN 2 5 2013
GIBSON COUNTY AUDITOR
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