Homestead_AllerellieCLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
State Form 5073 (R13/ 12-09)
Prescribed by the Department of Local Goverment Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
I (We) Q 1` r 1.5 A P re I � 1 'e certify that I (we) occupied as my (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby Claimed
er contract on the date this application is filed, (date of filing). I (We):
Own ❑ Am (are) buying under recorded contract
Am (are) emitted to occupy as a tenant - stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
Name of claimant (legal name)
Social Seaairy number of claimant (last Am digals)
Drtvers license I identification t Other number
Issuing State
of claimant tig irs)
O sl
Name of claimant's spouse (legal name)
Social Security number of claimant's spouse (last rise dgBs) Odvers license I Identification /Other number Issuing State
of Claimant's spouse (last rive d0b)
Em
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number
Page
••
Township Taxbg disb ct (' , town, township)
Parcel number
Legal description j
Is the property in p
- 0 a - -t OO --700
I - d I-7
1 E341teal property ❑ Annually assessed mobile hone (IC 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
Crony Township County Township
I hereby certify the above statements are true, Correct and complete.
Signature of claimant
C
Address (number and street, dry, std and ZIP code)
0
®RMEMIMSENUMM7
m ;.
Land not exceeding 1 (one) acre immediately , j , � ^<-�> ,�
. �.t -
- �s '- - * - - x-.• �
surrounding residential ire vements. (t) '",-
Other land
(2)
Total land (line 1 plus litre 2)
(3)
Dwelling
(4)
Residential Improvements or Annuafty
Assessed MohOe I Manufactured Home
Garage
a
x.- ,� ?�.�'�t`'•',.�� s � xa- ��.y�� }_
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus fine 7)
(8)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, )ear)
and complete.
Verifying action - Signature of Auditor Date signed (month, day, year)
20 pay 20 Lesser of 50% of the assessed value of the homestead or $45,000
Nan iUrstardbir any other provfsbn, the sum of the deductions provided N IC 61.1 -12 to a mobile home that's $
not assessed as real property or to a manufactured home that is not assessed as real property tray not exceed
one -had 12) of Me assessed value of the mobile home ormanurackmad tame.
Signature of Auditor �y
i`I
Date signetl (month,
7-/('-M'
•
' STATE FORM 53569(R3/S-I0) TREASURER FORM TS-IA
APPROS:ED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF ItrA3 GOVERNMENT FINANCE IC6-L1'2-8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS •
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
`auses 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.
PARTIi P'OPER 1' INFOR,11d ION .
Taa er oav Name Property Address State Parcel Number Leal Description:
Chris Allerellie POTTSVILLE LOT 418 26-02-22.300-700.954-017 POTTSVILLE LOT#18 P POTTS
HAZLETON IN 47670 ME 11009-00622-p0�0I�n1 Ig1+�IIf Mill pp��
Complete and return to: - I®11 o 01111100 ll]l]DOmm0W11WDJ El E mill OH
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
. PART?:TAXPAI'ER I\'FORMIATION • -
Owner I First Middle 11 II 11 Last
1 A �LercLh1t
� o�L� C � t' 1rS
Mailing Address Murder and street.city.state and ZIP code)
Sane as property address
3(Dy W 5Z 5 (2 K-4Z (�oAT.. J ynbLl O
SI... First Middle Last r
Mailing Address(nut and street.city,state and ZIP code) Same as property address
Social Security Nut(last 5 digits) Diver's License/State ID Nut(last 5 digits) Slate Other(please specify in Pane below)
PART3: 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 1 Si lure Date l
-
( ) •
PART 4:ADDITIONAL INFORMATION
D. .• . . .
0 • - - Nov- 7 -2nt2 - .
c.3.ty
GIBSON COUNTY AUDITOR