Homestead_TooleyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
J qq� State Form 5473 (R2 / 5-92)
INSTRUCTIONS: See reverse side for (ling instructions.
FORM YEAR
HC10
FILET-)
® CS CERTIFICATION STATEMENT APR 0
6 2001
I (We) certify on the 1 si day of arch, 19_
I (We) occupied as our principal place of residence the following described real prope for which a Homestead P erty T Cre rt is reby cl ' ed,
❑ I (We) owned ❑ Are buying under contract - GIB$ON CQUNTYa n
❑ 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 undBY�Cct.
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 (city, town, township)
Parcel number
Legal descriph
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 I County
Township
igd ,tire of c
ere y ce ify the above statements are true, correct and complete.
Adclress nilmber and street, ci state, ZIP code)
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 1/2 Homestead
$
Valuation or 52,000
Signature of Auditor
Date signed'
_ O
•
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Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD-PROPERTY OWNERS
101 N Main
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 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 verity that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county govemment to better monitor homestead
slings,this information will he kept confidential and can only be accessed by authorized roomy officials The Department of
Local Government Finance wild use this information to create tools that will help county officials eliminate homestead fraud.
, PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Tooley, Dennis R/Tamara K
•
•
RI 13ox 144 A
Francisco IN 47649
1142
Dennis R/Tamara K Tooley
6587 E 350 N State Parcel Number Legal Description
Francisco IN 47649-9275
ltl 26-06-30-200-001 723-017 009-00723-00 PT NE 30-1-9 45 AC
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• .r PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Dennis R.
—�c Address number mid sneer,n s_—_ _._ - — - —— --—
( ty, ffitC,eno LIY Code; - —-__ __ __ �_ �:wive m ewycu.ww.-.,— _ - _ _ _ _
Spouse First Middle Last
m549r� 14) 7DD.
Mailing Address(Number and street city,state,and ZIP code) Ed Same as prope v dress
'' deRu
�S ou
- •
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 �f Date
PART 4:ADDITIONAL;INFORMATION
S