Homestead_CorsentinoiCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
i State Form 5473 (R215-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
i
All CERTIFICATION 4ATEMENT
I (We) c try that on the 1 at day of March, 19_
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property TW Credit is hereby claimed:
RW _11
9 i (We) owned ❑ Are buying under contract TV
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or Uyi u r c E-
CONTRACT RECORDED AUG 2 4 1999
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded '
GIBBON ._gU^rTY AU
ITOR
PROPERTY DESCRIPTION
County Township -
Taxing district (oily,
r ber Legal description
a In
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 COUNTRIES
County
Townshi u Township
Signature of claimant
ereby certify the above statements are true, correct and complete. d
I
Address (number and street, city, state, ZIP code) _
L ✓
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding i (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2)
-
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other 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
complete.
Signature of Assesor
Date signed
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
ValuaIf or 1000
S �-•
Signature of Auditor
ign
STATE FORM 53569(R3/8-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 1C6-I.I 23-8.I
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
'ruses 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.
PAR I: P
Taznaser Name Property Address State Parcel Number Legal Description:
6860 N SR 65
Michael D/Susan NI Corsentino 26-06-06-300-003.080-017 PT NW SW 6 1 9 5.34 AC
HAZLETON IN 47640 (-06-30,/
Complete and return to: I11111h00]®Dm filOm110lf0®QOmmf110lml®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2:TAXPAYER INFOR,M.4TION
Owner 1 First Middle Last
Mafug Address(number and street city.state and ZIP code)
LO Same as properly address
6 2? 6D A,. Sfc't tad
Spouse First Middle Last
Stts Lh (Y\ Afie_ dory i7bno
Mailing Address(nut and street ay,state and ZIP code) itt Same as property address
•
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 1Signature Dat^
PART4:ADDITIONAL INFORMATION,-- .. ' - - .
411 IL JL IL' IL/ ILA
NOV 1 2011\ ///oJ
GIBSON COUNTY AUDITOR et�`t