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Homestead_DevineCLAIM FOR HOMESTEAD PROPERTY TAX FORM x STANDARD /SUPPLEMENTAL DEDUCTION HC10 State Form 5473 (R13 / 12-09) y� Prescribed by the Department of Local Govemment Finance INSTRUC77ONS., See reverse side for filing instructions. I (we) certify tha JAV o&6 my (our) principal place of re dence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed er n of on the date this application is filed, (date of filing). I (We): C.�. ❑ Am (are) buying under recorded contract ❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation GIBSON COUNTY AUDITOR ❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust ❑ Am (are) the shareholder, partner or member of the entity that owns the property. Name t (legal name) Social number ¢p>5) Driver's license, l� Name of claimant' l name) Social Security of claimant's spouse (last five dtg@s) • ••• If buying on contract, Fee Simple owners name Recorders office where contract is recorded Record number Page •. County Towwnship Taring district (dry, town, township) arrtA number Legal description Is the property in Question: ❑ Real property ❑ Anna% assessed mobile tome (IC &1.1 -7) If any portion of the residential structure or the IarM not exceeding one (1) acre that immediately surrounds that structure 's used to produce Income, describe the use and potion of the property Wined to produce Income. Pt � /ULr al- l- Ci l ?ryy County Township County Township I hereby certify the above statements are true, correct and complete. coomplete_ natu of claimant /� C /Ul/1¢L„r ►u,'.r'�, /_" -`'c• �IL-11�4l_v,�<- -,_ —'S' Address (number and speyq dry, state M LP rode) / �[J 5 N �i VIII•• —` rr'. • Land not exceeding 1 (one) acre Immediately (1) surrounding residential Improvements. .. ..- .�srre.... _ _'•i..' Other land (2) Total land (line 1 plus line 2) (3) Dwelling (4)Y'� Residential improvements or Annually Assessed Mobile / Manufactured Home Garage (5) Other Improvements (s) r wr Total improvements (line 4 through line 6) (7) Total value (line 3 plus line 7) (a) I hereby certify the above is true, correct, Signature of Assessor Date signed (month, day. year) and complete. Verifying action - Signature of Auditor Dare signed (month, day, year) 20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000 Notwithstanda)g any ofherpmvision, the won of the deductions provided in IC 6-1.1 -12 o e mobile home that is $ not assessed as real pmpeny or to a manufactured home that is not assessed as reel property, may not exceed ona-haff 1/2) of the assessed value of the mobile home or manufactured lame. Signature of Auditor Date signed (month, day, year) • , e • STATE 1O %I VV.tICI wt TRENLPfA FORM IS-IA APTROVEO BY[TITS B •RD OF.MTRI;T3.2ox PUS01111D BY air OEPART iT OF LAS tiMERYMEAT FB:A\\CE M 4-1.1::4.1 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 eser for homestead fraud.homestead fraud causes higher tax bills to 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.T11is information will he kept confidential and can only 1w,accessed by authorized courtly officials.The l)epanment of Local Government Finance will use this information to cream tools that will help count'officials eliminate homestead fraud. -__ P-ART1:_PROPERTY.INFORMATION--- < =-> --e Taxpayer Name Property Address Devine, Joshua L 4245 N 775 Ii FRANCISCO IN 47649 1119 Joshua L Devine 4245 N 775E State Parcel Number Legal Description FRANCISCO IN 47649-9257 1tlttlltttltlI.i.I.tlltlttlrlt.uiIiItltltli..I.Ittltitltl.iltl 26-06--21-200-003.262-017 009-03262-00 Pt SW NW21-1-917A4A0 PART 2: TAXPAYER INFORMATION Owner 1 First Middle Last ` oshua e5 +etc bev)ie .rg Address(numberim J Ttrvet city,state;and ZiP code) -- - -' — Smne us property address - - - -- - Spouse First Middle Last Mailing Address(Number and street,city,state,and ZIP code) Same as property address Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below) stew 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 1 Signature u VT s� Date S se Signature Date Telephone PART 4:ADDITIONAL INFORMATION •