Homestead_SmithCLAIM FOR HOMESTEAD PROPERTY TAX
It CREDIT/STANDARD DEDUCTION
N « State Form 5473 IRS 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FORM
YEAR
I (We) Qamlk4 yc�r C-VTC C \ I — certify that on the tat day of.March, 20_
1 (We) occupied as our principal place of residence the following 'beribed real property for which a Homestead Property Tax Credit is hereby claimed:
A(We) owned ❑ Are buying under contract
Wave 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.
- ONTRAcT It - - - - - - - - - -RECORDEW�-
It buying on contract, Fee Simple owners name
Recorders office where contract Is recorded Record number Page
i-IFA55 F K 0 R ft IRTTs D 1: 5 C R I FTI U N
County Township Taxing district (city .&EE�, township)
Parcel number Legal description Is the property in q tion:
Nu?s
U10 Q A !�7ndarflroperty ❑ Mobile Home (I.C. 6-1.1-7)
11 1!�l
If any portion of the residential structure or the land not exceeding we (1) am that immediatelAurrounds that stfuctureis used to produce income, describe the use and portion
of the property utilized to produce Income.
PROPERTY. C)WNED'BY,CLAIMANT,,IWbTHEW,60UNTlES� -� �,-?'- ,�,,°,",Cy
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
or(number and street, city, state, ZIP code)
STANDARD, DEDLJCTIONALLOWANCE
U EI TAV
20 _ Pay 20
:7
DWRESIDENTIAL;5
Lesser of 1/2 Home-stead
tly?k Q
VALUE
I
Signature of Auditor
Da ad
&—� —03
Land not exceeding 1 (one) acre immediately
surrounding residential Improvements.
Otherfand
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
Residential improvements or Annually
(4)
Assessed Mobile I Manufactured Home
Garage
(5)
O�gat improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action • Signature of Auditor
Date signed
STANDARD, DEDLJCTIONALLOWANCE
20 _ Pay 20
Lesser of 1/2 Home-stead
Valuation or $35,000
S
Signature of Auditor
Da ad
&—� —03
j SIAFE FORM:"3:01.0C1)wl TREASURER FORM TS-IA
.APPROVED BYSTSTE Bn&ROOF ACYCR■NTS.TUI PRFARIBWBY rat OFPARTMEYC OF LOCAL ri)ERVMFRT FPA\CE 1CVl.1-:_-r.t
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
tia
IIIP more beneficial.there is more incentive than e'er 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 reecho the
benefit anti to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kept confidential and on only he accessed by authorized county officials.The Ikpanment 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
Smith, Samuel P/Lois J
Box 338
Somerville IN 47683
8463
Samuel P Smith
5341 S Lincoln St PO Box335 State Parcel Number Legal Description
SOMERVILLE IN 47683-0335
IILIIItttlJlttLJtttIIIII IIIttILlLLrtIIilLlttrilll 26-20-02-403-000.281-003 020-00281-00 S&M ADD 8/9
•
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
SArnuel Piqtr-Ge m-i+h
�tg Address(number and street,city,state,and ZIP code) D Same as property address
P. O. Box Some lr rkle 1 1 V2 -
Spouse First Middle Last
Lots �JeAv Sm;4h
Mailing Address(Number and street,city,state,and ZIP code) []Same as property address
P.a • am( 333 Samery , .fin 57683
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 thip roperty:Eachundersignedalso understands-that by.claiming-additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I nature �,� / Date
PART 4:ADDITIONAL INFORMATION