Homestead_RobbY� CLAIM FOR HOMESTEAD PROPERTY TAX FORM
i
CREDIT /STANDARD DEDUCTION HC10 U
State Form 5473 (R2 15-92)
INSTRUCTIONS: See reverse side for filing instructions. I L.r 4
rl r\- .. - 11`° - -- "ICERTIFICATION.STATEMENT-
UWe) I a (J' certify that on the Is day of March; 19
kI e) occupied as our principal place f esidence the toll g described rea roperty for which a Homestead Property Tax,Creditis hereby claimed:
(We) owned ❑ Are buying under contract 4' CBS^" '.1=:"
❑ 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,..
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
'
PROPERTY DESCRIPTION' - - - -
County
Township
Township
Taxing di tnct . '�wnship)
,,,,,,((((((0000
Parcel number
9- o3ot�5_0C
L
al description
- I- ►�
It any portion of the resitlen[ial structure or the Ian not exceeding one (1) a 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
County
Township
.ereby certify the above statements are true, correct and complete.
Signature o aimant
Address (number and street, city, state. ZIP code)
ASSESSOR USE ONLY
TRUETAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON-RESIDENTIAL-
VALUE -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2.000
_ -•
-
Other land
(2)
1f 1 -,r
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(a)
-
Garage
(5)
-
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 jobs line 7)
(S)
1 hereby certify the above is true. correct, and
complete.
Signature of Assessor
Date signed
yirg anion - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE'" ! -
19_Pay19_
Lesser of 1/2 Homestead
$
Valuation or $2.000
re of Au itor
Date signed '
i� "i�
1f 1 -,r
MATE FORM!!S•IIC I3-1 TREASURED Po0.N:}IA
APPROVED BY STATE BOARD or,cnrNmA aov PRESTOS BY nir DEPARTMENT(W LOCAL GOVERNMENT FINANCE Ics4.t-u-u I
Gibson County Auditor D
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 e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires axpafers who receive the homestead standard deduction to verify that they are eli_ibte to receise the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kepi confidential and cm 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.
. PART 1: PROPERTY INFORMATION
Taxpayer Name Pro 1 e .'
Robb,Jeremy Wayne
RI Box 69
Hazleton IN 47640
27
Jeremy Wayne Robb
2506 E SR 56 State Parcel Number Legal Description
HAZLETON IN 47640
26-02-57-066-003.065-017 009-03065-00 PT MD 661 1011.11 AC
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
.J even„// CCM/it c- ?ob 4
•tg Address(numbe/end meet,city,state,and ZIP code) Same as property address
C9S0G F SO JR Litt/e foti y 4( yd
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) n Same as property address
Social Security Number(last 5 digits) Drivers License/Sate ID Number (last 5 digits) Other(please specify in Part 4 below)
Sat
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 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