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Homestead_MoodyCLAIM FOR HOMESTEAD PROPERTY TAX CREDIT/STANDARD DEDUCTION State Form 5473 (R5/ 10-01) Prescribed by the Department of Local Government Finance F kWD YEAR y AUDI I Un I (We) Y) certify that on the I st day of March, 20 I (We) Q2Cupied as our principal 1:1616f residence the following dew-L IL <Td real properly for which a Homestead Property Tax Credit is hereby claimed: (We) owned ❑ Are buying under contract aHave 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. ONTRACT.-RECORDED-. If buying on contract, I'm Simple owner's name Recorder's office where contract is recorded Record number Page i County Township county Township Taring district (city, to", forhip) 1 number Legal Is Me pope 0�q a gt, My ❑ Mobile Homo (I.C.8-1.1-7) If any portion of the residential structure or the Land not exceeding we (1) acre that immediately surrounds that structure is used to produce inoorne, describe the use and portion of the property utilized to produce income. i County Township County Township I hereby certify the above statements are true, correct and complete. Siyture.Ofa- 4 ..,.re. W 6E Address (number and street, city, state, ZIP code) i Q TRUETA ASSESSED '- gg q j t6iKTIALY NA 4 ..,.re. W 6E , : 00%70FTVftVAL a gt, Land not exceeding 1 (one) acre immediately .1v �5; surrounding residential improvements. Other land (2) Total land (fine I plus fine 2) (3) Dwelling (4) wMa Residential improvements Garage (5) 1040-7 111- improvements Other (6) Tctal 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 20 _ Pay 20_ Lesser of 1/2 Homestead Valuation or $6.000 Signature of Auditor )Date signed STATE FORM 53569(R318-10) TREASURER FORM TS-IA APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1 IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS, 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 'auses higher'tax bills for all; therefore,HEA 1344-2009 requires taxpayers who receive the homestead ss idard 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. PARTl:.PROPERTY-INFORMATION ` °g{7 Taxpayer Name Proper Address State Parcel Number Leoal Description: • tv Troy A Moody 6510 N NIXON RD 26-05-01-400-000.666-017 PT S SE 1-1-10 14 AC HAZLETON IN 47640 C-I Complete and return to: _ - - I©11011dlEllfQOmllim®®®D ® MINIM GIBSON COUNTY AUDITOR, 101 N MALN PRINCETON IN 47670 ul • . PART 2. TAXPAYER INFORMATION Owns First Middle Last /4 Afro,y Mailing Address(number and street,city.state and ZIP code) r _ me as property address 6 /O A 4J,,cJ Ed , n'e7"r✓ L`N (126 �d First Middle o�y Last •e,st Gi yam Mailing Address(number and street,oty,state and ZIP code) I l me as properly address L J _ �. PART.3::CERTIFICATION_;; r , 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,: ._ if E DEC 27 7°17 GIBSON t,OU"IV ntIOtTOR