Homestead_RichesonCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD. DEDUCTION
Stale Form 5473 (R215 -92)
INSTRUCTIONS: See reverse side Inr tilinn instructinns
•'
MAY 0y1W1
CERTIFICA NSTATEMENT -
�°'re) c if - ha 1 9
) occupied as our principal place of si t t Ito i e ribed real property for which a Home a�p,IopeA K AdiPl�ld i aimed:
I✓ 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.
CONTRACT RECORDED.
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES '
` - PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township) - -
Parcel number
LV de}po
-
IL
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
(2) "
Total land (line I plus line Z)
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES '
County
Township
County
Township
Oeby certify the above statements are true, correct and complete.
S. are of ai
-
Address (number and street, city. state, ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE.
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
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 plis line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Vying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE -
19 _Pay 19_
Lesser of 112 Homestead
Valuation or $2,000 S
Date signed
STATE FORM 51569(0.318.10) TREASURER FORM TS-IA
APPPOVrat BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY TIC DEPARTMENT OF LOCAL GOVERNMENT FLNANCE ICS-l.I 22-8.1
�- -s�IMPORT:ANsT NO:Ti10E•j�TiO�HOMES�TiE�AD�PROPER�TY OW.,N!ERS
'� �_ .�t.�,•ei�a-;yr„Rra> —'�tik �r�Ils.�Pr rmr-a
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
ibauses 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.
.r.a- >'-} ".--,< t.--,. P RTI: tPiROPE th I FOFiNtral:I1,ON
Taxpayer Name Property Address State Parcel Number Lent Description:
Carrie Shon Richeson 6337 N SR 65 26-05-12-100-000.667-017 PT LOT 2 FR 12-1-10 4 AC
HAZLETON IN 47640 C-I
Complete and return to: I1111hIO11111111flf]llft]INI1tH111Imm 111If1[1I111M
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
ergtileat-W '.=PAR+T_•TaaXPi\iYERINFOR17AeT10\ , . .. '. .(-"
Owner 11 +/��/���' First mode mode ���4�WT�•`e`+• Last
/�
Mathg Address(number and street city,state and ZIP code) I s pro aperty address
Spouse First Middle Last
Mating Address(number and steel city,state and ZIP code) 1 Same as property address
Social Seemly Number(last 5 digits) Drivers License/State ID Number(last 5 digits) sate Other(please specify in Part 4 below)
tit.r.Ve i `` e-n TOG E r) IC7Atf mss. _T1=
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is 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 t Signature Date
) •
9 x k* 5 P*RT4: ADDITIONAL;INFORklAiNOr
si eRTAXATIO,., x . >t
FILEDSubject to final acceptance for transfer
A I L I D _day of_�-- ---
• �J Auditor
FEB 6 2013 Gibson County
Parcel u
jjivAecdet-
GIBSON COUNTY AUDITOR