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Homestead_Fears (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR CREDIT /STANDARD DEDUCTION HC10 Stato Form 5473 (R71545) Prewfibet! by the Departrnand at Local Government France J* INSTRUCTIONS: See reverse side for Ring instructions. I (We) cv— certify that on daydm ", 20 1 (We) oacupi4as our principal place of residence rig descdlbad real property for which a Homestead Property=', is qeft0gWfled: I (we) owned ❑ Are buying under contra GISS014 COUNTY Have a beneficial interest in the entity that is liable for the property taxes an the property and that owns the property or is buying under a contract. CONTRACT RECORDED,, tf buying on mntracL Fee Single owner's name PaoNdeft office where contract is recorded Record number Page PRGPERTYDESCJU imb*ER couWhES W, County Township TGATWUP0 Tmang d' i kray town, (?Wnghp) $ -,-AT,.l Parcal--mardw VALUEY Is the poperty 4—� (nwdw and street, City, Sets, ZIP code) V Real property ❑ Mobile Hann (I.C. 6-1.1-7 structure or the land not exceeding one (1) amrs that imrnerliately surrounds that pliubture is used to produce vxxvre, descrbe the use and portion d the =L:km=W.= Incorne- (2) clo - 6 d 6) 0'6(D '-'Ok&Eifty mmm 9teLAnaNt imb*ER couWhES W, County Township County Township $ -,-AT,.l ALUE VALUEY I hereby certify the above stalernents are true, correct and corrOete. (nwdw and street, City, Sets, ZIP code) W34ess �Ct E SrK su STANDAJWDfMCTMALLOVPXCE,,,.,,- "�.TRUE TAX ASSESSEDiNW]i 4' 4W—SWENTLAL, Oki VAlatim or MWO $ -,-AT,.l ALUE VALUEY Land not exceeding 1 (one) am immediately (3 surrounding residential improvements. 5. Other land (2) Tdad land (Ikm I plus Em 2) (3) Na M -r Dwelli ng (4) Residential or Annually �-!"UKX Assessed Mobile I Manufactured Home r 3— MAI Garage (5) VICE Other irnpraverneirts (6) Tdal mprovernerds (One 4 through fine 6) (7) Tctal value (1h7e 3 plus fine 7) (8) 1 hereby am" the above is true. tarred, and Sgroture of Assessor Date signed complete. . Verifying adjon - Signature of Aiditar Data signed STANDAJWDfMCTMALLOVPXCE,,,.,,- 20 Pay 20 Lesser of 112 Homestead VAlatim or MWO $ &gnature of Auditor Date signed SLATE FORM!J•-de't urn TREASURER FORM:S-tA APPROVED BY St■E IridiDOF MTTAI\is. UW PlaltIBW BY mE DEPARTMENT OF LOCAL GOVELNYM7 FD:A'CE lC H.1-n-at 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 for all:therefore. ® HEA 134-1-2009 requires uapaycn 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 goverment 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. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Fears, Michael L/Angela J tI WY 56 Hazleton IN 47640 28 Michael L Fears 3849 E SR 56 State Parcel Number Lezal Description HAZLETON IN 47640 26-02-57-111-000.655-017 009-00655-00 PT MD 111 1-10 17 AC 0-12 This form MUST be returned to County Auditor's office. Please do NOT send this form back with your tax payment to the county treasurer. PART 2:TAXPAYER INFORMATION Owner I First Middle Last I ' I I b.) Le re 5 Ong Address(number and street.city,state,and ZIP code) RSnme as property address Spouse First Middle Last p n c -elm S20-01 Hie._ it 5 Mailing AddresS(((J��1:Etumber and street,city,state.and ZIP code) I I Same as property address s$`I I G- -T�e- t 0.61, 66, OL2 k1-6, • cri(Qcm 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. Ow y V Si „E Date � �c zti \_ 1/1160 PART 4:ADDITIONAL INFORMATION •