Homestead_BlantonqEf RA)♦
°. CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
�! CREDIT /STANDARD DEDUCTION HC10
., State Form 5473 (13215 -92)
Hsu
INSTRUCTIONS: See reverse side for filing instructions.')g –�
1 IWe) _'tS),c� i) __,1�`d � !✓ •certify that on ihy4(j�1al] nn{{;i�� 19
�:) occupied as our principa�p ce of residence the following described real property for which a Homestead operty Tax Cedd ithe laimed:
(We) owned ❑ Are buying under contract _
LJ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or AM eaWora co
_ CONTRACT RECORDED
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded - Record number Page
PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township) ,
Parcel number
bCj (o -aC7
Legal description
— .�.
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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
• eby certify the above statements are true, correct and complete.
Signal I claimant /{ /
Address (nu ber and street. dry. stare. ZIP code)
G,6 q1C 47; ! .
ASSESSOR USE ONLY
TRUE TAX
.VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE -
Land not exceeding I (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2.000
Signamre of Auditor
Otherland
(2)
Total land (line I plus line 2)
(3)
Residential improvements .
Dwelling
(4)
I
-
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plis line /)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 1/2 Homestead
$
Valuation or $2.000
Signamre of Auditor
Date signed
SlitE FORM!Kt.0711,.1.1 TM-Willi FORM 75-.!A
.1rrrm'Er,BYsr11Ea11rDrw YYYE IN/'C.2m x PRESCRIBED BY DIE DEPMn/LVr OFLO,ALnovEkNMrN't FINA NCE IC(.1.1-2:-A I,
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
more beneficial,there is more incentive than ever for homestead fraud.I lomestead fraud causes higher tax bills for all;therefore.
Ask-
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receise the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings this infnrmaunn will be kept conlidcruial and can only he 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: PROPERTY INFORMATION
Taxpayer Name Pr rt1'Address
-- Blanton,James B/Lora L
RI Box 80
Ilazlcton IN 47640
943
James B/Lora L Blanton
7095 N Shiloh Church Rd State Parcel Number Legal Description
Hazleton IN 47640-9260
ra 26-05-57-084-000.562-017 009-00562-00 PT MD 84 1-101.7303 AC
t o toIt II toI n III t I t I mi(t It II n I I raI t I t It ItI I l I
D-12 C-1
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
--
g A d O rt s{tnumDdr a n d stnx[;city:scam.arid ZIP code)-- - - _ _ _ _ _r-IS ix as property address-- __ - -_ _ _ _
/095 /l. SHILON Ciiti2cH l?o13D
Sponse First Middle Last
Lo 2R 2364n/7a„l
Mailing Address(Number and street.city.state.and ZIP code) ame as properly address
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 "'gnat e Arr./ Date
PART 4:ADDITIONAL INFORMATION
•