HomeMy WebLinkAboutHomestead_PetersonCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form, 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
F1 YEAR
MAY 1 D 2005
Kj-*ry7 of March, 20
eyrt—,
a hereby claimed:
1W a) occupied as # principal place of residence the following describecl` a �Mn,,Oea ®rmoiNpe PMN.V'K,
"N
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 or is buying under a contract.
C 0 N T RA C T, R E C 0 R D E D
If buying w contract. Fee Simple owners name
Reoorder's office where contract is recorded Record number Page
All� � !1,"'= PROPERT-Y-DES'CRIPTIONO�`-: N'Z.' -45�
County
Township
Taxing is ct (city, own, towns 4p)
Parcel n;,!,
L ld
Is the prope ne question:
set property ❑ Mobile Home (LC. 6.1.1-7)
I an portion of the residential structure or the land not exceeding we (1) acra that immediately stinnxjnds th
I y Nat structure is used to produce income, describe the use and portion
of the property utilized to produce income.
--i-�Z-g,4OiROPERTY�OWNEEIBYCLAJMANT;IN'OTHER-COUN ' r. -_ -. T1 ES
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Valuation or MOOD
07 (number and street, city, state, ZIP code)
ASSESSOR USE ONLY - ,� °.i
°TRUE TAB -} W
ASSESSED
5 %HOMESTEAD
Valuation or MOOD
$
Signature of ditty
4-,VALUEtZ;3t�:
AL E
V U
Land not exceeding I (one) acre immediately
K11
surrounding residential improvements.
Met land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
qi! zt h�wl -"k
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
t
improvements
(6)
,?;her
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Valtying acdon - Signature of Auditw
Date signed
DEDUCTIOWALLOWANCE,'
20_ Pay 2O_
Lesser of 112 Homestead
Valuation or MOOD
$
Signature of ditty
Date signed
...................................
STATE FORM 53569(R 15-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 106:1)-`1-5.1
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
nuses 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.
miff strinernirardilrersumil rs
Taspamer Name Property Address State Parcel Number Legal Description:
Ryan N Peterson 5289 N 775 E 26-06-16-100-002.500-017 PT NW NW 16 1 9 20.81 AC C-1
PATOKA IN 47666
Complete and return to: I®IIDO]CIlmflfD71'lluI�mlfillllfl0Ufl7�nitrtllfll®
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 dL IW IWI' II] n011'lll'
PART 2:,TAXPAYER INFORMATION
Owner I First Middle Last
� Mi
ah 4/ a
Mailing Addrejs(nunber and street.city.state and ZIP code)
I
Same as property address
- - . ,
First Middle . Last
Mailing Address(number and street.city.state and ZIP code) Same as property address
Social Seanty Number(last 5 digits) Dnvers Licenselstate ID Number(last 5 digits) state Other(please specify in Part 4 below)
PART3:CERTIFICATION . - '17 :3
Each undersigned certtifies.-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,+ taxes and substantial financial penalties.
COrma Sig,utur- \ Date
. - - PART 4:ADDITIONAL INFORMATION - •
-
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