HomeMy WebLinkAboutHomestead_WernzCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT /STANDARD DEDUCTION HC10
State Form 5.473 (R614 -03)
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for filing insiruclions.
I (we) r / / / / / &rt§ that e 1 t da f March, 20
(we) occupied as our principal place of residence the following d "bed real property for which ll HomeStf 'pe ty.3mc. is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract rT 31 2003
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns a property or is buying under a contract.
If buying on contract, Fee Simple owner's name
contract is recorded
Record number I Page
i._�- M "� "'" '�+"�1�`r�'+f'�r.._+ "'.'rss :.ff PROP,ERTY %DESCRIPTION ?°_- '„�ai��'.:.
= 'V
County a
T—ship
Testing district t ownship)
? Y\_
P um
description
a
L Z V
s Nperty in question:
❑ Real property ❑ Mobile Homo (I.C. 61.1 -7)
H any portion of the residential structure or the land not exceeding one (1) acre that immediately, unds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. QE -
'ASSESSOR�USE ON'Y '- '
' "TRUE TAX as
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
net , a of claimant
.�/(.r` t5'YltGtp
4ddre I embbe(rrJjand street, ,state, ZlP code)
R —'L I C.
VALl1E
'ASSESSOR�USE ON'Y '- '
' "TRUE TAX as
'AASSESSED VALUE.
p HOMESTEADS
NON,r�tESIOENTIAL - -
'
a ,.
ALUEIc,..
ATt100 hmO nTeTy.
VALl1E
VALUE"VO
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
t-
Other land
(2)rl``.-
Total land (line f plus line 2)
(3)
Dwelling
(4)
VT7
-
ResidentiallmprovementsorAnnually
Assessed Mobile I Manufactured Home
garage
(5)
.1 _
c j-dam
Other improvements
(6)
's
a
Tclal improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
vauabon or 535.000
Date
STATE FORM 535sisu,-rl TREASURER FORM IS-IA
MP ROVED BY SLATE MaRDOE MM"R]%TS TWO PRF3AIBW BY THE DEPARTELYEOF LOCAL GOVERNMENT FINANCEICbLt-T2r.l
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PR4NCETON 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.Ilomestead fraud causes higher tax bills for all:therefore.
® HEA 1344-7009 requires taxpayers who receive the homestead standard deduction to verily that they are eligible to reecho 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 Property Address
Wernz, Thomas M
RI Box 167
Patoka IN 47666 Y I
756 r� (i
Thomas M Wernz of
R 1 Box 167 State Parcel Number Legal Description
PATOKA IN 47666-9207
26-05-22-100-000.424-017 009-00424-00 PT LOT 3 22 1 10 1.811 AC
ru niIt II nt I I nt I I I tI I l I I I ntI luI tI I tI I lI tI t I
V D-12 C-1
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
j Morne-5 Mil-RT/4 WE2NZ.
ng Address(number end street,city,state,and ZIP codej- --- — " --- - - Same as property address-- — — —
a6d{ll" r 400 ,t/ oafsn, /N 4-766b
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sole
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
Spouse Signature (/ Date Telephone r l
PART 4:ADDITIONAL INFORMATION
•