Homestead_Collins (4)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Deptubnent of Loral Government Finance
INSTRUC77ONS: See retertfa &I* Axe iWbyc6orim
FORM EAR
H 10
IAN 2 7 mnn
I (We) C a7
I on theft „y o�f✓iNarch, 20_
1 (We) occupied as our p ncipal 1 face sidence the following desci d pr a for which a Homest F�l hlllhfT6�laimed:
❑ I (We) owned ❑ Are buyi under contract
Have 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; - RECORDED,- x;'r'a+�
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
��_:,a't= r�:'��•.ea��-'""'�',' PROP. ERTY, OWNEDr61! CLAIMAIJTIN:OTHER`COUNTIES,iF,�`.,,t;
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W&MM&IA PROPERTY .DESCRIPTIONfr'1'?'`.; ..`f3�'a'- ;r?:r- 'L^,„-
County
hereby certify the above statements are true, correct and complete.
I . ature of l imant
Township
Toung district (ci
ow Np
Parcel n
Legal description
Is the property question:
surrounding residential improvements.
Real property Mobile Home ILC. 61.1 -7)
H 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.
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County Township
County Township
hereby certify the above statements are true, correct and complete.
I . ature of l imant
mber end t, city, state, ZIP code)
(/
i�STANDARDMEDUCTIONALLOWANCE
20_Pay20_
Lesser of 1/2 Homestead
Valuation or SM.000 S
Sign at o tli Date signed �J
HOMESTEAD F
ix NON -RESIDENTIAL 0'137+
��. 1: VAL UE.�3s"3.`-
,
C,.S..VALUEa =-au'.
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2).
Total land (line 1 plus line 2)
(3)
Dwelling
Residential Improvements or Annually
Aaaessed Modb / Mantdac0rred Home
Garage
(5),k
•'ys3rrs.??
Other improvements
(6)
'” �".,
MR
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Arditor
Date signed
i�STANDARDMEDUCTIONALLOWANCE
20_Pay20_
Lesser of 1/2 Homestead
Valuation or SM.000 S
Sign at o tli Date signed �J
•
MATE I OR>I•JMIB-',.Ot niusut1lfirs-1A
A PROcED BY MATE BO.ROOr MY-EA::l PV3(R®En BY 11IE OFPAREAMATI OF LEAAE cOJ_0.W.,wT EINAAY'N It_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 tttnynes
more beneficial,there is more incentive than ever for homestead fraud Homestead fraud causes higher tax bills for all:therefore.
® HEA 1344-2004 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information neccss ry to allow county government to better monitor homestead ,
filings.This information will he Ley confidential 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 horcncstcad fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address /J/
Collins, Larry W/Jeffrey Eugene 7%/ ° (e• The .5�
Sweppy G( •at-"-Col
H bi0
967
Larry W Collins/Jeffrey Eugene Sweppy
2962 N County Rd 850 W State Parcel Number Legal Description
Hazleton IN 47640-9645
IuIIIl IIII�III111lrr lllrtrltltr rl'rr ulr rut lr lit llrlrr lrl lrt rll 26-05-57-110-000.783-017 C-1012 OO PT MD 1701-1025 AC
PART 2:TAXPAYER INFORMATION - •
Owner 1 / / I r ' / First Middle Last
Y
,Carr, • , at.tr LG/2 S
111-g.Address(number d'veet,ary,yar^ 21P`eodc) -- f U-,,tune uipagnaty-aidacas __ __ _ _ -- .,
SfeSr 2 First Middle Last
t
� 1 2: trI 17
.reccri e Scu e pDY �u `� /
Mziling Address(Number and street,city,state-an eode) Same as property address
crl ,7 5c, ted A-( dO
'
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 Signature �j Date
PART 4: ADDITIONAL INFORMATION
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