Homestead_Hyneman (3)E nE3
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC1
State Form 5473 (132 15-92)
au
INSTRUCTIONS: See reverse side for filing instructions.
9 1994
- CERTIFICATION STATEMENT ,�.
I (We? _ m cj� �, .N ate. 1 certify that on the lshday oi-Mg(lr�th�, s
so) occupied as our principal place of residence a following described real property for which a Homestead Property Tax Credit is°hefeby
❑ Are buying under contract I .
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
It buying on contract. Fee Simple owner's name -
Recorder's office where contract is recorded Record number Page
1
PROPERTY DESCRIPTION
County -
Township
Township
Taxing district (city town, township)
IAddress
1^ (number and street, city, state, ZIP code)
If 6o 03q �f_76
(1)
Valuation or $2,000
Parcel number
Legal description G-,
`ICDo
-1- ..1
h any portion of the residential structure or the land not exceedi g one (1) 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
Township County
Township
eby certify the above statements are true, correct and complete. Signa a of claimant
IAddress
1^ (number and street, city, state, ZIP code)
If 6o 03q �f_76
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 $2,000
-
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 (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
Date signed
STANDARD DEDUCTION ALLOWANCE
19 _ Pay 19
Lesser of 1/2 Homestead
S
Valuation or $2,000
Signature of Auditor
Date signed
srvt ruaM=sw.,c I LIS, IFI SUraa FORM tz:A
.Vmrnin al Brut 30V1OFw&"NrS. OII rRLM'tatrDnl Tw.OVARIMLrOI LOCAL COV'LS ML't nv.ccrcru.l:+.t
Gibson County Auditor -IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS:
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. A. the receipt of this deduction becomes
Princeton. IN 47670 more beneficial.there is more incentive than ever Ibr homestead fraud.Homestead fraud cause_higher.tax bills for all:therefore.
FILED HFA 1344-7004 requires taxpayers who receive the homestead standard deduction to%erify that they are eligible to teethe the
benefit and to provide additional identifying inlhrmauon necessary to allow county government to better monitor homestead
filings.This information will be kepi confidential and can only be accessed by authorized county officials.The Depanmert of
Local Government Finance will use this information to crane took that will help county officials eliminate homestead fraud.
MAY 4 Z012 - PART I:PROPERTY INFORMATION
Taxpayer Name Location Address
C �.K Hyneman, Donald R
5857 E 650 N
GIBBON COUNTY AUDITOR IIAZLETON IN 47640
2783 II 1
Donald R Hyneman (II-I�III]DII�IIJI.�IIDIII II VIII �I�II II�DIIDII_II_III Il IIII�III�II�II�I�I�II II
5857E 650 N
Hazleton IN 47640-9347
tllltlllltllttllllrl'Illllll�ltlllltllt�lll�l�"I'1��1'llllllll'I State Parcel Number Legal Description
26-06-07-100-000.466-017 PT NE NW 7-1-9 27.24 AC C-1
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.
_..-.___PART2:TAXPAYER INFORMATION ;,_- _ _,..,--�_— _—----___
a I First Middle Last
-c eln
Mailing Address(number and street.city,stare.and ZIP code) o Same as property address
r so A) flk iYto.. X/UCiN 'o
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver'
s License/State ID Number (las:5 digis) Other(please specify is Part 4 below)
l I l I l l Snee
- - • 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.
net I Signature Date
u Signature • Date Telephone r l
'I PART 4:ADDITIONAL INFORMATION