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Homestead_Mays (2)CLAIM FOR HOMESTEAD PROPERTY TAX } CREDIT /STANDARD DEDUCTION State Form 5473 (R2 15.92) ' Feu INSTRUCTIONS: See reverse side for filing instructions. FORM YEAR HC70 tM) \ Q _ certify that oj(4p j� ttay(df Mai4yr_L I (We) occ i d as our principal place resiIidence �tth{{e >�folloging scribed real perry for which a Homestead Property Tax CW U!narIP claimed: ❑ I (We) owned ❑ Are buyit;unde�nFacI . ❑ 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 If buying on contract. Fee Simple owner's name Recorders office where contract is recorded Record number Page PROPERTY DESCRIPTION - - County Township Taxing district (city, town, township) P rcel�nu e- 000-7n -nb Legal descri .o c ignat I daimant Address (number and street, dry, state, ZIP code) It any portion of the residential stw5. � or the land not exceeding one ) ae that immemately surrounds that structure is used to produce income, describe the use and portion of the property utilized to income. PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �ty Township County Township I hereby certify the above statements are true, correct and complete. ignat I daimant Address (number and street, dry, state, ZIP code) It It ICA 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 S2,000 ' Other land (2) Total land (line I plus line Z) (3) Residential improvements Dwelling (4) Garage (5) Other improvements (6) Total improvements (line 4 through line 6) (7) Total value (line 3 pbs line 7) (g) _I.hereby certify the above is true, correct, and lete. Signature of Assessor Date signed _..tying action - Signature of Auditor Date signed _ STANDARD DEDUCTION ALLOWANCE 19 —Pay 19_ Lesser of 1/2 Homestead S Valuation or S2,000 Signature of Auditor ii ) ^ ^ Date signetl �. IIATE FORM!!!4.11C:fl-1741 MEASURER FORM S.IA nrPR)vEO BY AVE BMAoor rr*M15 us PRESCRIBED BY THE BETAaneJHw LOCAL CawrR'MFn FB:ASCE It'4-lbSI.l 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 more beneficial.there is more incentive than ever for homestead fraud Homestead fraud causes higher tat hills for all:therefore. HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verily that they are eligible to receive the benefit and to provide additional identifying information necesmry 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 hip county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Mays, Jesse O 701 I )4 NI XOD Rcp R 1 13oa 152 B Hazleton IN 47640 6I 178 ����CCCC.... Jesse O Mays _ _ R 1 Box 152 B 1 v7 \1 \ 3)<or State Parcel Number Legal Description Hazleton IN 47640-9322 Itl tt��t rr�r��rrr�rrllltt t�t�ttrr��rrr ltlrr�rllrtt ltt t�lTlrlt� 26-05-01-200-000.070-017 C009-00070-00 PT N FR 1-1-101 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. PART 2:TAXPAYER INFORMATION Owner I First Middle ��� fast e_,SSe ©Wen ong Address(number and street,city,state,and ZIP code) ff(Same as property address Spouse (("�� First Middle Last HCf1CAIOnG ACIQ Cn1� S Mailing Address(Number and street city,state,and ZIP code) I�I Same as property addrF-- '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 I Signature Date • PART 4:ADDITIONAL INFORMATION •