Homestead_White (3)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing inslruclions.
FORM PEAR
HC10
I (We) /OL litr/c�rti that o th 1st da o(Ma
I (We) occupied as our principal p ce of residence the following descnbed r (1perty for which a Homestead Property Tax Credit is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract OCT 2 3 2003
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.
L4 /1
CONTR,4CT RECORDED, ��:; y?n2:f "',- Sati"Vs#-£{i:;..'ELf9J J_!.''�'..:c2`sas
If buying on contact, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
.,` -_�- . F`•' tnr-'-- vA' L.*? z�s�:=.'--
PROP ,ERTY,'�OWNED�BY:CIIAIM/1NT<IN'
isP,ROPERT,YsOESCRIP.TIbN
Caun
rLg1I p
Township
Taring district (cr o wnsh )
I hereby certify the above statements are true, correct and complete.
0
escriptio n
.Address \
Is the prope in uestion:
IP code)
A It IN
property ❑ Mobile Home ( /.C. 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that s cture is used to produce income, describe the use and Portion
of the property utilized to produce income.
'id.�..�r- .'?�#'?�".�"
PROP ,ERTY,'�OWNED�BY:CIIAIM/1NT<IN'
OTHER' COUNTIES,.,'`?:>, ,`'Ws,-'a�x._.�`,v>;g,+Zp"'rz`5
County
r -'�
INON-,RESIDENTIA
�'
Township
County Township
I hereby certify the above statements are true, correct and complete.
I a a
^: VALUE`',f�,
... �:
.Address \
L dry, stet
IP code)
A It IN
f ASSESSOR USE ON Y 3'F
� � -'
'TR E AXar
ASSESSE VALUE
„� HOMESTEAD -'-
§: K
r -'�
INON-,RESIDENTIA
�'
r--� �ALUE
{ — - "IL 'X 4M'f�.S�.t {t`ay.-
AT,'100 %.OFTTV_VALUE
AN .mY,EF:..
^: VALUE`',f�,
... �:
Land not exceeding 1 (one) acre immediatety�
surrounding residential improvements.
Other land
m
Ull
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)-
ads 2, Y ;S "i=nr -%kiw
rj ~µ -` �s
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(6)
,s,-
'�
Other improvements
(6)
a
Total improvements (line 4 through line 6)
(T)
Trial value (line 3 plus line 7)
(6)
I hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
•
STATE FORM!!.w TREASURER FORM 73-IA
.APPROVED BY SINE BOARD OF Art cywR ym PRES1BFD BY TUE DEPARTMENT OF LOCAL CArRYMnr'r FINANCE tc F,r_a.l
Gibson County Auditor Main
101 Dl IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead saandanl deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than eter for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
HEA 1344-22009 requires taxpayers who receive the homestead standard deduction m verify that they are eligible to teethe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept c nlidcauial and can only be accessed by authnrired county officials.The Department of
Local Government Finance ill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
White, Jason D/Leafy A /13;41> f N e 11/kh
1H 11156C
Ilazleton IN 47640 ?
944
Jason D White
7391 N Shiloh Church rd State Parcel Number Legal Description
Hazleton IN 47640-9259
�t�t t��I rt�t��rrt�rr���rlt�r�IrFr�t�r�r�t�r IrRrt!�t�rt�� 26-05-57-084-000.941-017 001200941-00 PT MD 84 1-10 4.008 AC
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• . PART 2: TAXPAYER INFORMATION
Owner First { Middle `\W M& Last
g Address(numberand strcc city:sate;and ZIP code)- _ _ _. - _ . .[1:3,,SeatErs property uddres —'— - - - -
- -
Spouse First A , l Middle t /k1� Loa
I'IL//'t'wri\` W I
Mailing Address(Nom and sweet,coy,start.and ZIP code) rte as property address
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 +'`
!PART 4:ADDITIONAL INFORMATION
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