Homestead_SutherlandCLAIM FOR HOMESTEAD PROPERTY TAX FORM Tn I ( � Y
ti CREDIT /STANDARD DEDUCTION Hc10
S J State Form 5473 (R4 / & u
00) _
INSTRUCTIONS: See reverse side for filing instructions.
I (We) {}i that'.'. NAL day of March, 20_
1 (We) occupied as our princip ace of residence the following described real property for which a Homestead Property Tar Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract %✓V1 1?
®iave a beneficial interest in the entity that is liable for the property taxes on the property and owTthelp�sr(y� or OQ- ngRunder a contract.
ur o...
�,���i a"*?- . ^e5€°� £•: �t'�°"��CO_NTRP,CTjf- RECORDEb�& ?mow- �i�;- cr�r :,:rp�Y�i°���'`�r'i�_7f_.'4
If buying on contract, Fee Simple owners name -
Recorders office where contract is recorded _ - Record number Page
Township Taring dis , to , town to)
0,5136 Legal tlescri p n / /� - ! �^
It any portion of the residential structure or the Land not exceeding one (1) acre that immediate surrounds that structure is used to produces income, describe the use and portion
of the property utilized to produce income. -
�vY„�"�;r -,� �,.'t�.PROPERTY!OWNED BYAC�_L._A'IMANT'IN_OT1iER
C0_UN_ TIE_ S—', �zi*"• �- ie, ?b-' �K�; �. t-^°" ,�''`- �Y''�s�`"'_y.,1�;`�$'"'
County Township
County Township
I hereby certify the above statements are We, correct and complete..
Signature of claimant
Q
-, r1VAL`UE .r
Aid (numberand street city, state. ZIP code)
R. 4 I
'tr #tee•.
rF i ASSESSORIUSE,ONLY ""'+"`
TRUE' A C
tASSESSED YALUE
<
UV��i �
aHOMESTPO
_ '�"'�
.-ANON= RESIDENTIAL
' cTC �- -�. M—
-, r1VAL`UE .r
t%AT''100°/'OF�t_TN
ROM. AUUEErs�•�
t �t �' VAL'•11E�" .
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Ki ,y•, `M=
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)�
Residential improvementst�
_
Garage
(5)
-
Other improvements
(6)�£'''`"
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature or Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation or $6,000
S-a /
STATE FORM 53569(R315-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1 22-8.1
•INIPOR■ ANT NOTICE TO HOtiIiESTPAID-PROPERTY.OWNERS'
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
ieduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
ii, 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.
�' _ l4q e.e o 'R•.Y IhYxo77L3VS�5il[ ( . .-.. .
Taspayer Same Property Address State Parcel Number Legal Description:
Anthony B Sutherland 5410 E SR 56 26-02-47-008-003.130-017 PT LOC 8 110 3.47 AC
HAZLETON IN 47640
Complete and return to: Il11II11Il[II1II:II!IUIIllllllflll111111IIBlDDUmllld➢IIIIIIIIII
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670•' - ,':: 1 ; ailiINFORR'lA•TiION • • .
Owwiiner 1 First nn Middle rr nn Last
tt�Ler j IJf0Ce S LA- herI2nd
Mating Address(numbel and street,city,state and ZIP code)
Same as property address
x First Middle Last
Mating Address(number and street,city,state and ZIP code) Same as property address
SAID . S4 . P+-. St
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
( )
., •+ 14.PART4ADDITIONAL INFORMATION ti -- C ,
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