HomeMy WebLinkAboutHomestead_HurstCLAIM FOR HOMESTEAD PROPERTY TAX a� FORM YEAR
CREDIT /STANDARD DEDUCTION
Slate Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.;'' ,j V
(We) U r certify that onrthe,lst.day.o6March, 20
—1,
1 (We) occupied our principal place of residence the following described real property for which a Hornestead'Pro perty Tax CFediiis hereby claimed:
❑ I e own GISSC^7 ,.. .
(W) ❑ 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.•. {-1,--+�,�.js�`:� 'r �c� ;t. �;��, +• -'8:. -"rw ^'Y -
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If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
�€"�" ,} - s"=:''� =-t'u. ''•,l$r',s""?
e: v,' P, ROP, ERTY .DESCRIVIONo�rt��'^,�_`.'".,�,�
County
Township
Taring district (city, town, township)
r
Legal 'Ptl
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Is the property in question:
?VALUE
�,j>L
❑ Real property ❑ Mobile Homo (I.C. bf.1 -7)
H any portion of residential structure or the land not exceeding one (1) ace that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. 11
ROP .ERTY.OWNED;BYCL•AIMANT,IN OTHER COUNTIES ,�� ?��'i]`.�•fi�}``, _.u"lf- "'���1 '•".�4
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
i at claimant ,.
•fdress num r
(stre L city, state, Z code)
Un6ILI
12 NXaES50RUSE ONLYx z37d+.. r
Will
TRUE TAXr ;tf
ASSESSED VALUE
rHOMESTEAD
ANON- RESIDENTIAL
M&VALIIE
AT 100 %VOFTfVtj
?VALUE
� VALUErj ,�.'.�`
Land not exceeding 1 (one) acre immediately
t:r`,§)•�'y��ti N i.?z
IS.
surrounding residential improvements-
Other land
(2)13
Total land (line 1 plus line 2)
(3)
Dwelling
(4)°K''1�,�y
s
Residential improvements or Annually
Assessed Mobile I Manufactured Horne
Garage
(5)
4,
Other improvements
(6)
F'•w.: c -' a
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
, #>r .-_rtrS ;
TANDARD DEDUCTIONALLOWANCE
4'lr _ 3"?JS?i:3 -a•...
20 _ Pay 20
RW Lesser of 1l2 Homestead 5 r
Valuation or 535.000
Signature of Auditor Date ed
.. - e
SISTE rne4 iitta tle/s,nl itrsst&FA FORM:Si.t
.SrrROVED eT STSTE F AM°tN MYTT:TS.!vr, rrLRlnam BY THE DEPARTMENT OF LOCAL Grct'SMrNT FINANCE M41.1-L'4.l
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples arc limited to one homestead standard deduction.As the receipt of this deduction becomes
mom beneficial,there is more incentive than Bier for homestead fraud.Homestead fraud cause higher tax hills for all:therefore.
HE:\ 13-14-2009 requires taxpayers who receive the homestead standard deduction to verify that they am eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will he kepi conlidenrinl and ran only R accessed by authorized county officials.The Depanntent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Hurst, John/Monica
RI Box 61 A
Francisco IN 47649
1069
John/Monica Hurst
6165E 500 N State Parcel Number Legal Description
FRANCISCO IN 47649-9223
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PART 2: TAXPAYER INFORMATION
Owner I First �-� Middle Last
ox/.2 / r;:(//1 / 4/S-C4--
-- re Addreis(number t ii stree,city,state sid ZIP code) - - _ '- .'Same us property adds;—- — - - ------
1111,
Spouse 14 First Middle / / Last
/20 et qa (LA irs zi--.
Mailing Address(Number and stmt,city,state,and ZIP code) a as properly address
'af
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 Date
__ � - - 2\--„/
PART 4:ADDITIONAL INFORMATION
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