Homestead_Tipton •
STATE FORM 05691R2 I%YI) TREASURER ftSM INIA
APPROVED BY STATE BOARDER ACCOUNTS,2109 PRESCRIBED BY THE APARTMENT OF LOCAL GOVERNMENT FINANCE C 6-11:_.x I
.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 indentifying 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
Property Address(number and sweet,city,state,and ZIP code)/� t ///� �`�/'/��///7 FILED
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State Parcel/ / V e /net 04.44 /1. 6 g g AJ
46- 0../-- J-9_/02- 0°7 9e fa a /2
FEB 14 2014
GIBSON iCOUNTY��/Vk AUDITOR
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Mailing Address(number and street,city,state,and ZIP code) n Same property perty address
.
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/State ID Number (last 5 digits) Other(please specify in Part 4 below)
stair
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.
OVS l ti Signature R � " " ( � Date
Spouse Signature
Date Telephone
)
PART 4:ADDITIONAL INFORMATION
/I_Sral TM T�4 .OnWTr /_
i
INSTRUCTIONS
rt CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
Slate Form 5473 (861403)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing insimctions.
FORM SEAR
-HCtD
OCT 2 2 2003
I (We) ���� certify that oror�ihelisFday "ol Nit�r�[I;!2D.a I
P occupied as our principal place of residete the following described real property for which a Homestead Property Tax Credit is hereby claimed:
e) 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.
sr fn hr
NTRAC
COT ?RECORDED
If buying an contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
: -emu;=, ���asa =. •.Z.r,P= �.sa.�
-2>, 7�wa04 P, ROPERTY .DESCRIP.TIbNIYe.",�;` -�„?� .� Y-1r'
County
Township
Taring dmtn I (pity, to towns '
/s(rthe
Parcel number Q
Legal description
Is property in on:
VALUE` �¢`.f
t°> --3�,
Real property ❑ Mobile Home ( /.C. 6-1.1 -7)
If any portion of the residential structure or the land not exceeri g one (1) am that immediately wmounds dial structure is used b produce income, describe the use and portion
of the property utilized b produce income. %7, �ry�
Ll
%. ter !'.- 'A-�i�P,ROP.ERTY;OWNED,BY. CLAIMANT
-IN,' OTHER `COUNTIES',u`61..Si- L:fifj
County Township
County Township
I hereby certify the above statements are we, correct and complete.
Sig a laimant
Address (number and street, city, state, ZIP code)
.r 9.....a'i
ASSESSORNSE ONLY -
�
RUE,TAX
`'"AT�100
ASSESSED VALrUE
°h'OFTTV
crsHOMESTEAD,f
. tNON- RESfDENTW
?E i9 v�c� ;,.n < wu
+
yAL:UE-
SL..�_..`.'4.+ -Y••
.r 9.....a'i
VALUE` �¢`.f
t°> --3�,
Land not exceeding 1 (one) acre immediately
y o,.
surrounding residential improvements.
Other land
(2)-
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
tat
Assessed Mobile I Manufactured Homa
Garage
(5)
_
Other improvements
(6)
.-.,.�,. -. ,v
d.ix
Trial improvements (line 4 through line b)
(7)
Total value (fine 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
srov=-
%- `��- ��_���s STANDARD:DEDUCTION ALLOWANCE-tt"�;.�.�''t�i' Silk' av«-- 1„ a., ,'.` � '= �3.�_ii,.,":�- y��s- ....�" -k-.'
2(a Pay 20 Qq
Lesser of 112 Homestead $
vauatlon a f35.000
Signature of Auditor � Date signed