Homestead_OttenCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instnictions.
,(we) r L.-o w.4% ff- CjrLggA0"fij&&g&4A cerAjhatJLA4d�o__
I (We) occupied as our prinval place of residence the following described real property for which a Homestead Property Tax Credit Is hereby claimed:
I (We) owned ❑ Are buying under contract MAY 10 2005
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the proptime or is buyAriq Mpder a contract.
If buying on contract, Fee Simple owner's name
Recorder's office where contract Is recorded Record number Page
fj?.PK'fvif--I.`. PFiOPERTYDESCRIPTION4��_.,
County
Township
Timing distinct (cif); town, township)
=,:r cc)
hereby certify the above statements are true, correct and complete.
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the property in question:
X 1'ktVALUg3,
� ❑ Real property ❑ Mobile Home (i.C. 6-1.1-7)
It any portion of the residential structure or the land not exceeding we (1) am that immediately surrounds that structure's used to produce income, describe the use and portion
of the property utilized to produce income.
CLAJMkNTaIN:OTHEFi�CbUNTIES,�l
�', k- n
County Twnship
County
Twvnship
hereby certify the above statements are true, correct and complete.
Signature of claimant
dress (number and street, city, state, ZIP code)
USE r-'
T RUE TAX
kSSESSED,'VV6ii
:0,'HOMESTE4115-_
''�If�'��'NOWRESIDENTIAL
tASSESSOR iONLY�u
2' r%VAL E
OATS qj�T,_W
VALUE�#V,_5�
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Land not exceeding 1 (one) acre immediately
surrounding residential Improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
V_1W z
q
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
-
M
V !�T
improvements
(6)
,?bet
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
DEDUCTION'ALLOWANCE-f.,-,.
20 _ Pay 20
Lesser of 112 Homestead
Valuation or 535,000 S
Signature of Auditor
SLATE FOAM e'a.jCI■wl ME SMR FORM 75-1A
.APPROVED BY STATE annum AMiet 10 rwnaBED BY THE DEMARTE4Tlf LOCAL r4NELVMrAc F*t%CE tC 4.1.1---AI
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.I lomestead fraud causes higher tax bills to all:therefore.
HEA 1344--3009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to eceve the
benefit and to provide additional identifying infomtaton necessary to allow county government to better monitor homestead
filings.This inlhmsatinn will he kept confidential and can only he accessed by authorized county officials.The Ikpanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Otten, Lana J/Therese M Weist
Hazleton IN 47640
112
Lana J Otten&Therese M Weist
10892 N 500E State Parcel Number Legal Description
HAZLETON IN 47640-9312
�t�tt��ttt�t��ttt�tt���ttt�t�ttrt��tttt��tt�t��t�rttt�t�tt��t� 26-0247-002-000.171-017 009-00171-00 PT LOC 2 1-10 1.2314 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
LANA 75 o TTEA/
g Address[number and street,city,state;anti Zi'r code)-- -- —— —171-Same as property uddress — - - — -- - -
/ O92 4/. 5A/..(:M LAA/6 HmzLEroA' 11-761-/o
Spouse First Middle Last
Mailing Address(Number and street,city,stale,and ZIP code) [] Same as property address
Social Security Number(bast 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sue
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 eliuible 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 1 Signature Date ,
Spouse Signature Date Telephone
)
- PART 4:ADDITIONAL INFORMATION
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