HomeMy WebLinkAboutHomestead_RainboltCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
,W CREDITISTANDARD DEDUCTION HCio
State Form 5473 (R215 -92)
.emu.
INSTRUCTIONS: See reverse side for filing instructions.
I VU L Y 2� K—A-Z „AI t6A /"A-. V Mkf`V.- � certify that on the 1st day of March. 19
as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
(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 i bt inju� or r
RECORDED
II buying on contract. Fee Simple owner's name
r�1TA0
Recorder's office where contract is recorded Record number Vhqe
PROPERTY DESCRIPTION
County
Township
Taxing district (
iry.
Land not exceeding 1 (one) acre immediately I
surrounding residential improvements.
mber(�nl�)7 L,{/
_ v _ / Ol 0
Legal description
it any portion of the residential structure or the land not exceeding one (t) acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township I ^” Township
I
® eby certify the above statements are true. correct and complete. 5 n ure ofd
Address (numb r and street. city. state. ZI )cod )
Z i x l6-7- 17/r LI.. ?Zyo
ASSESSOR USE ONLY
TRUETAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately I
surrounding residential improvements.
(1)
Valuation or S2,000
Signature of Auditor
Other land
(2)
Total land (line 1 plus line Z)
I (3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
I (7)
Total value (line 3 pirs line 7)
I (6)
1 hereby certify the above is true. correct. and
complete.
I Signature of Assessor
I Date signed
.eying action - Signature of Auditor
L
I Date signed
STANDARD DEDUCTION ALLOWANCE
19 - Pay 19 _
I li
Lesser of 10 Homestead
S
Valuation or S2,000
Signature of Auditor
Date signed
' STATE FOI. c3/8-10) TREASURER FORM TS.tA
APPROVED 6 .TE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I 1-22-8.1
:4 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
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.
? W'nr .. = '' -"', -arw PARTI PROPERTYINFORMATION „ qi'* ;i -trf'
Tasnaver Name Property Address State Parcel Number Le-al Description:
Daniel/Davama Rainbolt 6322 N SR 65 26-05-12-100-000.704-017 PT LOT 3/PT LOT 2 FR 12-1-10 7
HAZLETON IN 47640 AC C-I
Complete and return to: IVHIlI'IIVII]tI:u111111 111111I019IIu!V1�111 01SIiiiii
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
Owner 1 First Middle /-- last
th 7 saig�-vv )AN.-z--r
mg Address(number and street,city,state and ZIP code)
Same as property address
6322- 4/, S7 (s- A-a(qT ,C27v_ Y774d '
Mailing Address(number and street,city,stale and ZIP code)
LI oats as property address
: � ' :"**
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 1 Si atu Date
:`.1
FILED
JAN 2 9 2013
N COON.i T RuuttaR