Homestead_Davidson (4)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
.,, State Form 5473 (R2/5 -92)
reL _
INSTRUCTIONS: See reverse side for filing instructions.
e).Q, _ _ _� certify that on the 1st day of March, 19
11) occupied as our principal place of resideA69 the following des-c-ribed real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying 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.
CONTRACT RECORDED _
I 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, tmyn. township) T
Parcel number
Legal description
0 o°t - Uo 13(. -ap
eby certify the above statements are true, correct and complete.
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
TRUE TAX
,VALUE
County
Township
County
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Township
eby certify the above statements are true, correct and complete.
Signature of
Signature of Auditor
Other land
(2)
Address (number and street, city. state, ZIP code)
7G a
(3)
- a
ASSESSOR USE ONLY
TRUE TAX
,VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL.
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2.000
Signature of Auditor
Other land
(2)
Total land (line I 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)
(g)
I hereby certify the above is true. Correct, and
complete.
Signature of Assessor
Date signed
gng action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 Pay 19_
Lesser of 112 Homestead
S
Valuation or $2.000
Signature of Auditor
Date signed
STATE FORM 53569(Kits-10) - TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1.222 41
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. HomesteadIraud
*uses 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 1: PROPER Y t`FOR,MA ION
Timmer Name Property Address State Parcel Number Lee al Description:
Susan Davidson 4842 E DEAD LEVEL RD 26-02-47-008-000.136-017 PT LOC 8 1-10 1.09 AC
I-IAZLETON IN 47640 IBS
Complete and return to: IMIIIIMMu]ffERI fllBlI!J11]II➢QOIImff9@IIDI1
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART?: TACPAI'ER INFORtIATION
Owner I First Middle Last
5ILSau IU • ,j)av :OS a0
Mailing Address(number and street city,state and ZIP code)
Same as property address
. ,[4-6qa 2-tEa Le_vFl ck H zlcto u t,) 4710 Fb
-
sp, 9 9 g -.5— F'usl Middle Last
Mailing Address(number and street.bb.state and ZIP code) Same as property address
Social Security Nunter(Last 5 digits) Dover's License/State ID Number(last 5 digits) Soo Other(please specify in Part 4 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 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 Date
Spouse Signature Date Telephone
( )
. PART 4:ADDITIONAL INFORMATION - TT _
• DG ;- i i9 0 i6- 96'? / '
• Nov b 2012
^ M T \v
•
GIBSONCOUNTY AUDITOR
•