HomeMy WebLinkAboutHomestead_Johnson (16) •
s1VE/MAW,.I R`r Yr't 17SANtrI FOAM TS-1A
•PRP'ED BY SLOE :KIM OFnmx_Nr&FN, PirrAlnm or ME DEPARPZENT Of LOCAL ant ILNMIKirr:Asl`E IC i...1-2.:4.1
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
®F a more 1344-200 there r more incentive w h than ever for homestead fraud.d deduction fraud causes higher are bills for all: cbt therefore.
916pa1—J. 2 HEA ten+?009 requires taxpayers who receive the homestead sra d.Homestead
to causes
that they are bills fo al:there the
ibenefit and to provide additional identifying information nececss.ry to allow county government to better monitor homesread
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 tads that will hrlp county officials eliminate homestead fraud.
APR 1 2 zuw PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
7yf47� /6�� Johnson, Dale R
GIBSON COUNTY AUDITOR RI Box 116
Hu/Teton IN 47640
18
Dale R Johnson
9287 N Salem Lane State Parcel Number Legal Description
HAZLETON IN 47640-9 5
I I I III la.N 111,1111111111111111111111111111111 z6 oz-a7-oos-ooz.7ss o17 009-02755-00 PT LOC 8 1 10 1.44 AC
t tt Irr I rrt III
- -- -- -— — -- — -- —
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 T Last
4,,
ing Address(number and street,city.stale,and ZIP code) / me as property address
.2I ) &, $/9-! gn'r, in), ,161z/e71-0e, .Z d -) f vo
Spouse ( First Middle Last
Mailing.Address(Number and street,city,state.and ZIP code) 0 Same as property address
- Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
slate
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 elieible 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 I Signature Date
Spouse S -' Date Telephone
( )
PART 4:ADDITIONAL INFORMATION
•
rt� CLAIM FOR HOMESTEAD PROPERTY TAX FORM
y��[e CREDIT /STANDARD DEDUCTION HC10
State Form 5.473 (1215 -92)
yu
INSTRUCTIONS: See reverse side for filing instructions.
YEAR
. - .._. CER_TtFlCAT10_ _N. ATEAAENi+ •,-.,,, . ' - .
P We) _ certify that —�'.thlaflst'day of Marctl,•,19'
.'a) occupied as our principal place of residence the following described real perty for which a Homestead Properiy�l�c C�edit�is here y.claimed-
iS 1.S 1 l w -L L,,d
I ❑ I (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 the property ajApuylhg)unf @contract.
I _ _ - - I CONTRACT RECORDED_. -_„ _ ,XLz�:.:.t�`:; �_r %�� A'-- I
If buying on contras. Fee Simple owner's name r- laltlJViJ (;UUiliY At!L'!:C I
Recorder's office where contract is recorded Record number Page
- -
- PROPERTY DESCRIPTION _' ° - :- "-
County
Township
Township
Taxing district (pry, town. township)
Parcel rum
Legal description
_ r L1
It any portion of the residential structure or the land not exceeding
of the property utilized to produce income.
bne (1) acre that immediately surrounds that structures its used to produce income. describe the use and portion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
ereby certify the above statements are true, correct and complete.
g ,lure of claimant
rAddress (number and street, city, state, ZIP code)
5
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL`
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
5
Other land
(2)
Signature of Auditor
Total land (line 1 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 plus line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
0ifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE �P
19 _Pay 19_
Lesser of 1/2 Homestead
5
Valuation or $2,000
Signature of Auditor
Date si red