Homestead_ShanCLAIM FOR HOMESTEAD PROPERTY TAX
J
CREDIT /STANDARD DEDUCTION
State Fonn 5473 (R215 -92)
t
INSTRUCTIONS. See reverse side for filing instructions.
NOV 16 2000
STATEMENT
I (We)�KJIiu3,Y�P� —RCS if (WtWll #W4 "TAM
I (We) occupied as our pnnc al place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
We) owned El 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
If buying on contract, Fee Simple owners name - -
Recorders office where contract is recorded
Record number
Page -
PROPERTY DESCRIPTION
County
Township
Taxing district (a town, township)
Parcel number
Legal description
If 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.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County Township
County Township
ereby certify the above statements are true, correct and complete.
Signature o la nt
.
Address (number and street, city, state, ZIP code)
2 It T o
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Otherland
(2)
Total land (line 1 plus line 2)
(3)
-
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
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 Assesor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 112 Homestead
5
Valuation or $2,000
Signature of Auditor /
Date signed
STATE FORM 53$o (RS/8-10) - . MA51i511 FORM TS-IA
APPROVED BY STATE BOARD OF AMOUNTS.SO9 MEMOREX)BY THE DEPARTMEVT OF IMN.GOtf%MEN7 FINANCE IC 6-1.1-224.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, 47670 more beneficial,there is more incentive than ever for homestead Lauri Homestead fraud causes higher tax bills for all;therefore,
- _HFA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible Co 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.
PART 1: PROPERTY INFORMATION - -
Taxpayer Name •`. Location Address
'�,r--- T_ - Shan, David L
Ifs p ^I 4793 E SR 56
'HAZLETON IN 47640
26 • APR 14 2011
' David L Shan = C . � I II[I�I131111111111-1111111110111111011011-11_ _ _III 01111_III I I IIIIIII M 111 II
4793 ESR 56 ,
Hazleton IN 47640 GIBSON COUNTY AUDITOR
State Parcel Number Legal Description •
26-02-57-126-000.805-01 7 PT MD 126 1-10 5.273 AC PT MD
113 1 10 .829 AC
,
This form MUST be returned to County Auditor's office.
lease do NOT send this form back with your tax payment to the county treasurer.
PART 2: TAXPAYER INFORMATION
ner I ` First - • -Middle Last
ilingg}Address(number and street.city.state,and ZIP code) - 1•— - [lam a as property address
use • First Middle . Last
ling Address(Number and street city,state,ind 7.IP'ctide) -- - ' -r - Same as property address
al Security Number(last 5 digits) - Driver's LicensefState ID Number (last 5 digits) - .. Other(please specify in Part 4 below)
1 III iII
I PART 3:CERTIFICATION
h undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she ineligible to
ive the homestead standard deduction on this property.Each undersigned also understands that,by claiming additional homestead deductions
rwfully,he or she may be liable for back taxes and substantial financial penalties.
SIi . Date
e Signature Date Telephone '
( )
I PART 4: ADDITIONAL INFORMATION