Homestead_HadleyCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC7o
State Form 5473 (R215 -92)
Asia
INSTRUCTIONS: See reverse side for filing instructions.
® >) ll'b'k.L�Ln).!� -� � F�J_�g j �� _ certify that on (�{Q�j(I day2f M1@r�Fr; 19
I (we) occupied as our principal place of residence the following described real property for w ' a Homestead Property ax Credit is hereby claimed,
L6 I (We) owned ❑ Are buying under contract, /1 T/���p1,iUy�f —�
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prope�nPy/ovr�isM- tJy���RdCf f3 contract.
CONTRACT RECORDED
It buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
ASSESSOR USE ONLY
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
PROPERTY DESCRIPTION
HOMESTEAD
VALUE
Township
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Taxing district (city, town, township)'
f
Parcel number
COs CO
i ripto
Leg e
- - U .
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income. d scribe the use and portion
of the property utilized to produce income.
ASSESSOR USE ONLY
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
HOMESTEAD
VALUE
Township
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
County
Township
,reby certify the above statements are true, correct and complete.
Sgnature of Au itor (D
Si9n�tur f aimant
X
re5s rr`'mper
/G• 63
d streer dry, stare. ZIPcode
/ /
`t
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 52,000
Sgnature of Au itor (D
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 (tine 3 jobs line 7)
(6)
I hereby certify the above is true, correct, and -
r- mpfete.
Signature of Assessor
Date signed
WMg action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 Pay 19_ .
Lesser of 112 Homestead
S
Valuation or 52,000
Sgnature of Au itor (D
Date si ned
9 ` //
' 'UiE FORM!)!•IP./f'!'1 tREASURER FORM iSIA
ArrR.tn OT STATE bORO OF ARYA Nfl 5e PR/SCRIBED BY THE DEPARTMENT OF LORAL CM"RYMENT FINANCE IC 6-1.1-r4.1
%CETONIN4767O Main ty Auditor Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married coupin are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than es er for homestead fraud Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to teethe the
•� frnefrt and to provide additional ipt nlm_ information allow youth government to better monitor homestead filings.This information will be kept confidential and ca n only accessed by authorized count y officials.The Department of
Local Government Finane<will use this information to create tools that will help county-officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Hadley, Dennis D/Diane B
Well a;09-064
__ _ Hazleton IN 47640
2013 — - - - - - — - — — -
Dennis D/Diane B Hadley
2411 E SR 56 State Parcel Number Legal Description
HAZLETON IN 47640
26-02-57-063-000.654-017 009-00654-00 PT MD 63 1-1010.50 AC
PART 2:TAXPAYER INFORMATION
Owner I ^ First � Middle � � � l�
Last
e
J NNE(/S
---�tg Address number and street,city,state,andLIP code)—
Spouse First Middle / Last
01 et)v e_ N e
Mailing Address(Number and street,city,state,and ZIP code) -Same as property address
all 66 R • Tnv 90 6q()
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.
Own 1 Signature - Date
PART 4:ADDITIONAL INFORMATION
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