Homestead_WhittingtonCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION t
Slate Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for Winn insir rtinns ,
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�`y: .r,- u"',)��- �".?}_"'i2 „�" �f�' T- ;`` -'i <" � ': �`? � "CE_RT_1FICATIONSTATEMENT -l:ri I - Ear'. Y'" .>.`�•_ �..:''�i�'+is: --'�_.
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I (We) N, ceni th h 20
9
I (We) occupied as our principal place residence U e Following de ,ribed real properly for which a omestead Property b , by
(We) owned ❑ Are buying under contract
0 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.
)
'. .r.d:,?"- %.''"i`^fr''`�...�..•. *`t-.q.`°'e CONTRACT:'RECORDEDi...'_ ni' -�+i y -...
If buying on contract, Fee Simple ownees name
Recorder's office where contact is recorded Record number Page
- �`��r��'��s•r�"i�'..ti :�5- -.. t$; °�Y 3? �;:' �:,.�::PRO�ERTY.DESCRIPTION���- art+ a�3�. �'? r'`.' i?? `�'�`'- :���?'.,"�a'�a`'fii,*�i; srs�;�.
County
Township
Testing district (tiy con, township)
Parcel number
_
Ct _r<6 1 —
Legal description
I
'
Is the property in ques :
eal property ❑ Mobile Home (I.C. 6- 1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acne that immedialety surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
�''��` -5 �:,�'�fA- -s'�?^ Aix,` �iPROP. ERTXUWNEDBY: CLAIMAN 'f <INrOTHER'COUIJTIES'L�"x ;�yg"�€Q3�`,�`°�:'.r�''�"t
County
Tmnship
HOMESTEAD
County Tovnship
I hereby certify the above statements are true, correct and complete.
Signature of laimant '
' ress (num6eraM street, city; stare, ZlPCOde)
f'• � /3 Ss rL acs
4-7
�y' -- "•4' i5`-' at ci -'�r-
�TRUETAXz fir•
ASSESSED VALUE
HOMESTEAD
='NON-RESIDENTIAL
§
..` A _3 ,UNLY'>?VALlJE31W'S
aAT 700 %OP.'S -,ar-
VALUE±
�.�LV�~VALUE"
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
r� £il -W
Dwelling
(4)-
�,,' _ ,p..} -u�
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
' N'- ss
5
()
a
-so
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 Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
s STANDARD '.DEDUCTION'ALLOWANCE�.w�c ei.`n:�s��?.�un- �..- -"ks✓ -k_ x. ""`�'
20_Pay 20_
Lesser of 172 Homestead S
Valuation or S35.000
Signature of Auditor Date signed
J
STATE FORM 53569(R31 3-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC5-1.1-22-8.1
- 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
*uses 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 l
homestead fraud.
- !AR IT-PROPER YINFORMA ION'
Taxpayer Name Property Address State Parcel Somber Legal Description:
Benjamin C Whittington 4295 N 650 E 26-06-19-200-001.781-017 PT SW NE 19 1 9 17.17 AC
FRANCISCO IN 47649 C-1
Complete and return to: I®hIDOI®1111COnthll1 Hi m�fI71f11rtlpinitn�II EMI
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 7 1L9111LllRNlf L!L
• - PART 2: TAXPAN'ER INFORMATION
Owner I First Middle Last
AL/P9/I/;,i d4 4 r /P s . AA(.7f.;s
Mailing Address(number and street.cry,state and ZIP code)
I I Same as property address
1/429s N &Tso E TrAt- iC ;SCp .r/ti • 4/7 Cy9
Spouse First Muddle Last
Mating Address(number and street,dry,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers LicenselState ID Number(last 5 digits) Sue Other(please specify in Part 4 below)
, PART 3: CERTIFICATIQN• • - ' - - - -•
'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.
Ovmer I Signature Date
. PART 4:ADDITIONAL INFORMATION . .
Mir