Homestead_Hartley t.
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Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited io one homestead standard deduction.As the receipt of this deduction becomes
S more beneficial,there is more incentive than e'er for homestead haul Homestead fraud causes higher tar bills for all:therefore.
HEA 1343-2009 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
filing`.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
Hartley, Michael J
R 1 Box 95
Patoka IN 47666 I R
265 33
Michael J Hartley
R 1 Box 95 State Parcel Number Legal Description Y/
. Patoka IN 47666-9122
IFlrtlltttlFlltrtlltttllttltltttttlltrlFlttlFlrrrlllFlrrlrrrll 26-05-57-092-000.100-017 009-00100-00 PT MD 921-10 .55 AC
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.
Owner 1 First / Middle Last e___,0 ser
aping Address(number d and street.city,state,and ZIP code) „El Same as property address- f
33/9 /: 7P0 /� 4A/c.< _Za ✓�`�a ll7Zl6
Spouse First' // Middle 4,4 Last
Gistk /� -!e Mailing Address(Number and street,city,state,and ZIP code) 0 Same as property
33/9 e tin Av Ca c -9,4-/ ,V6-‘ 4
--- — -- .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/1pr back taxes and substantial financial penalties.
Owner 1 Si e if Date
- (((/
PART 4:ADDITIONAL INFORMATION
ae CLAIM FOR HOMESTEAD PROPERTY TAX
} CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
u
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
I (We) / V tom, UH L certify that on the 1st da��1r,p(pp(µµMMarch, 19
�e) occupied as our principal place of residence the fol mg described real property for which a Homestead Prop@j ax�r�diYBaiAreby claimed:
t (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 thropertymL4gyip&.g1 r acL
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Town �p
Taxing district (crty, t to. hi
r
4
Parcel number
Legal description
DD - Gb /oo —oo
Other land
If any portion of the residential structure or the land not exceeding one (II 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
County
Tovmship
County
Township
'e e t a ve t ements ar true, correct and complete.
Signature of claimant
d ess (number angWreet, dry. stare, ZIP code
/0 95 a or. . 5176 6(0
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
V anon or $2,000
Signature of Auditor %
Other land
(2)
I/- ' s--
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(6)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(g)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
IM
Date signed
_ - STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 1/2 Homestead
S
V anon or $2,000
Signature of Auditor %
Date signed
I/- ' s--