Homestead_LamarI.
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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (1112/6-09)
'O Presuibed by the Department of Loral Government Finance
INSTRUCTIONS: See raverse side for filing instructions.
FORM YEAR
HC10
-' I I _P Tl
�CERTIFICATION STATEMENT
I (We) , cetify r that I RE) "1481 �Mour) principal
place of residence or am (are) buying the property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ I (We) own ❑ Am (are) buying under recorded contract �n6�•
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation GIBBON COUNTY AUDITOR
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
PROPERTY
County
T nship "
Tazirp,dist>vY (dry, town, township)
Parcel number
Eegal description O A L
Is the pmpeg in question:
5 4.2 S (0 -' - 9
1 ❑ Real property ❑ Annually assessed mobile home (IC 5- 1.1 -7)
portion of the residential suucWre or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
ot property utilized to produce income.
l1
I,;Llo- Olo -p(D- boo -0001 0 b 5 -0/7
PROPERTY .:
County Township
County T 1hip
I hereby certify the above statements are true, correct and complete.
signature of dolma t A /
Address (number and street cdy, state, and LPeode)
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE • • • r
AT rt'. OF
Land not exceeding 1 (one) acre Immediately
surrounding residential residential im rovements.
Other land
(2)
°dr',vy
Total land (line 1 plus line 2)
(g)
Dwelling
(4)
,y
v- . xz,,`��.
..3- ri- a[g.- S��}+wi u:3
Residential improvements or Annually
Garage
(5)
Assessed Mobile I Manufactured Home
Other improvements
(6)
Z.. _3 �. ti:i: rY1.•
Total improvements (line 0 through line b)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action. Signaure of Auditor
STANDARD • r
Data signed (month, clay, year)
20 _ pay 20 _ Lesser of 67 of the assessed value of the homestead or $45,000
Nahvithstandug any other pmvislon, the sum of the deductions provided in IC 6-1.1 -12 to a mobile tpme that is
S
not assessed as real property or to a manufactured home that is not assessed as real property may not exceed
one -hall (112) of the assessed value of the mobife home or manufactured home.
signaW aor ,v
Date signed (rrpnfh, day, year)
STATE FORM;3569(RNB-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICb-I.1-22-t.I
a IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
auction becomes more beneficial, there is more incentive than ever 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 receive the benefit and to provide additional identifying
information necessary to allow county government to better monitor homestead 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 tools that will help county officials eliminate
homestead fraud.
PART': PROPERTI' INFO•a MA ION
Taxpayer Name Property Address State Parcel Number Leeal Description:
David A/Leesa 1 Lamar 7244 N SR 65 26-06-06-200-000.065-017 PT SW SW 6-1-9 1.20 AC
HAZLETON N 47640
Complete and return to: IlifiIIUII1 fIm1 BEIlI�117�n1n111111111E 111111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 aJ IIJIIJIIJ1Lll n 1WIWl
- -,PART 2: TAXPAYER IYFOR,\IATION
Owner 1 First Middle Last
1)a V lel A \\e n 1.a.ina,r
Stang Address(number and street,dry,state and ZIP code)
Rv r
wrx as property address
'7214 N. 5 R Cos J--)az ldo n I i 47Gga
PART 3: CERTIFICATION
Eadiundersigned 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 I Sgnabae Date
' ,
1:4- • -Eli- 1LED-7 — ,)
DEC 4 2012 ////
C3:rrw v
GIBSON COUNTY AUDITOR