Homestead_FarrarCLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
CREDIT/STANDARD DEDUCTION HC10
IN State Form 5473 IRS 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions. -P
E R T1 F I C ATI 0 N, STATE M E N TO
I (we) f rertilAtAVOI IV ?OW of March. 20
1 (We) occupied as our prin0pal place of residence the Olowing described real property for which a Homestead Property Tax Credit is hereby claimed:
Q I (We) owned ❑ Are buying under contract
ave a beneficial interest in the entity that is liable for the property taxes on the property and that o r 0 �e@o rs, tbr
R,�6pr a contract.
WWBN'Br� NTY A
:.-z4 iiCONTP.ACT,,RECORDED,r.-'V-:
If buying on contract, Fee Simple owners name
Recorders office where contract Is recorded Record number Page
A T DESCR
�Y, I P, T
County
Township p
Township
Taxing district (city, to", township)
Parcel be r
0
L al description
Lesser of 12 Homestead
a property in question:
❑ Real property ❑ Mobile Home (I.C. 6-1.1-7)
It any portion of the residential structure or the land not exceedfibBone
of the pniperty utilized to produce income.
(1) am that immediately surrounds that structure is used to produce income, describe the use and portion
�g;.�l-qFiROPERT-Y'OWNE&,f3*CLAJMANTIWOTHER7COUNTIESzei ,,�.i—�";-
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
eas (number and sheet, city, state, ZIP code)
&STANDARD IDEIDLJCTIOWALLOWANCE'
k TRUE ,TAXN-,-�,
WiibWi6iVk&IE
HOMESTEAID:�
tt ,�4.NOWRESIDENTIAL'
Lesser of 12 Homestead
Land not exceeding I (one) acre immediately
Valuation or $35,000
Signature of Auditor
surrounding residential Improvements.
Date signed
6- -/O
Other land
(2)
"
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
A
Garage
r ? a'r "
Assessed Mobile I Manufactured Home
(5)
.?;bar improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
&STANDARD IDEIDLJCTIOWALLOWANCE'
20_ Pay 2O_
Lesser of 12 Homestead
Valuation or $35,000
Signature of Auditor
Date signed
6- -/O
Is
STATE FORM 53569(R3/5-10) TREASURER FORM TS-IA
.•. APPROVED BY STATE BOARD OF ACCOUNTS.:ow PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.I23-8.1
ti IMPORTANT,DIO.TICE TO.HOIVIESTEAD PROPERTY OWNERS • t w _ _
Individuals and married couples a ; '11 . • 0 1 n estead standard deduction. As the receipt of this
a^duction becomes more beneficial, t i f• ° re i c� t t !an ever for homestead fraud. Homestead fraud
causes higher tax bills for all; the ' Ir.,' 12If! ' equires taxpayers who receive the homestead
standard deduction to verify that they are ritiv ibl 9 ttbfi ceive 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 lckst• '- uthorized county officials. The Department of-Local
Government Finance will use this information ate tools that will help county officials eliminate-
GIBSON cRflf firer gud• - ' `
T
' : /"t: > - -e PARTI-PROPERTY INFORMATION
-resumer Name Property Address Slate Parcel Number Lees!Description:
Benny R Farrar CR 1750 W 26-16-30-777-701.117-023 CABIN ON LSD GRD
GRIFFIN IN 47616 STONEBERGER CAMP LOT 28A
Complete and return In: - - - • iiii hill iiilGiialiiiiiiiiiiliiu:u1GllVuiGilliiiiiilii
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
,' fir'
- " PART 2: TAXPAYER INFORMATION it-Y`r .-uW`
it Last
t
C r A I. j_1 F— it 6 r
Matting Addr- s( •. •street cty.state and ZIP code)
,,e//\\\,^^, '' 1 ri Same as property address 7
Spouse First Middle Last
Matting Address(number and street cly,state and ZIP code)
r�Same as property address .
Social Security Number(last 5 digits) Drivels License/Stale ID Number(last 5 digits) state Other(please speedy in Part 4 below)
-
:::-C. ' ? ._ A� -�-'r' - — �-�-=` 4�:-.,T5; "P4iIGaN= ..- " '>rY^;� y.-�v%�+�-It�p.,iz.-•-r. afnHF.�4".v�R-1[a'«w.n:- -
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
;:
rt