HomeMy WebLinkAboutHomestead_Conklinda 4 CLAIM FOR HOMESTEAD PROPERTY TAX
s y CREDIT /STANDARD DEDUCTION
' State Form 5473 (R2/1 -90)
U4 ju
INSTRUCTIONS: See reverse side for filing instructions. TM
I
CERTIFICATION STATEMENT
FORM - YEAR
HC10
I (We) OxKl zC _ / certify that on the 1 st daffy oT Ma ti99 9
I11(We) occupied as our principal pl e of residence the following described real prop f r t (Oh �}�l& stead
broperty Tax Credit is hereby claimed: 0--r (We) owned ❑ Are bAjItQ rr c'o'ntract
❑ 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 it under a contract.
CONTRACT RECORDED
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded Record Number Page
PROPERTY DESCRIPTION
Cour}i*j T wnship Taxing District (City, town, township)
(� c55�-
Parcel Number Legal Descrip on
If any portion of the residential structure or the land not exceeding one (1),acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
my T wnship County Township
I hereby certify the above statements are true. r ct and ignature
omplete. �y
dress (Street. number. city. state and ZIP code)
ii — 1 0.
ASSESSOR USE ONLY _ TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Otherland
Total land - line (1) plus line (2)
Residential improvements Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
_
(1)
1991 Pay 1992
19 —Pay 19 —
Lesser of 112 Homestead
(2)
Lesser of 112 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or S1,500
(4)
-
- -
-
(5)
(6)
(7)
(8)
1 hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
1990 Pay 1991
1991 Pay 1992
19 —Pay 19 —
Lesser of 112 Homestead
Lesser of 112 Homestead
Lesser of 112 Homestead
Lesser of 112 Homestead
Valuation or $2,500
Valuation or $2.000
Valuation or $1,500
Valuation or S1,500
Si t re o1 Auditor
Date Signed
is -a -9
C/
STATE FORM53!04I2'/.tiN1 MAMMA FORM 13-IA
.APPROVED BY STATE KM°OfArrYL%TC.US r MUTIED BY 1W.DL?ARTVO4T(4 LIRAL COVER-WMAT FD:&SCE lc.-0-_al
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS '
PRINCETON IN 47670 Individuals and married couplo are limited to one homestead standanl deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ewer for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 134-4-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to freebie the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and can only he accessed by authorized county officials.The Department of
Local Government Finance will we this information to create tools that will help roomy officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Conklin, Robert J/ Mary Ann
5142 F SR 56
Hazleton IN 47640
177
Robert J/Mary Ann Conklin
5142 E SR 56 State Parcel Number Legal Description
Hazleton IN 47640
26-02-57-127-000.058-017 009-0005E-00 PT MD 1271-10.45 AC
PART 2:TAXPAYER INFORMATION
Owner I et 1 First t Middle C ' O N // f ) ) last
—_
Social Security Number(last 5 digits) Driver's License/State II)Number (last 5 digits) Other(please specify in Part 4 below)
V 75414. 5t ? o 5
Spou;e First h1iddle Lc Last
may Ai G
Other(please specify in Pan 4 below)
- L} 74 L4 seas --- 6 1 .7
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.
gi1 Si at tire Date
•