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Homestead_BatesCLAIM FOR HOMESTEAD PROPERTY TAX FORM �j CREDIT /STANDARD DEDUCTION NCio State Form 5473 (R2/5-92) y• INSTRUCTIONS: See reverse side for tiling instructions. FIL YEAR .-•.CERTIFICATION STATEMENT_, FE ([;, n. p- 1� -.�Q. I (WE certify that oDIA A Haytbf`f.Yarch, 19 1 (We) occ 4ias al place of residence the following described real property for which a Homestea Property Tax Credi�1J hereby dai I (We) owned Are buying under contract,1JJ.,r Have a beneficial interest in the entity hat is liable for the roe taxes on the property and that owns [he ro erty orSs"tlDyin under Mntract. IY property M P P y P Pe Y n 9 _ - :CONTRACT RECORDED,.. If buying on contract. Fee Simple owner's name Recorders office where contract is recorded Record number Page -- °° PROPERTY DESCRIPTION - County Township Taxing district (city, town, township) Par nu er Legal description P — /, D/ / /� pi(.- ^ �— } It any portion of the residential structure or the land not exceedin one ( ) ave that immediatbly su unds that structure is used to produce income, describe the use and portion of the property utilized to produce income. ress (number and street, dry. state, ZIP code) - PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES County Township - County Township I hereby certify the above statements are true, correct and complete. Sin a of claimant ress (number and street, dry. state, ZIP code) VALUE ' ASSESSOR USE ONLY �TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL` ' - VALUE VALUE VALUE VALUE Land not exceeding 1 (one) acre immediately surrounding residential improvements. (1) Otherland (2) a - - Total land (line 1 plus line Z) (3) Dwelling (4) Residential improvements ' Garage (5) Other improvements (6) Total improvements (line 4 through line 6) (7) Total value (line 3 pbs line 7) (6) I hereby certify the above is true, correct, and Signature of Assessor Date signed complete. Verifying action - Signature of Auditor Date signed STANDARD DEDUCTION ALLOWANCE"'`.- 19 Pay 19_ Lesser of 1/2 Homestead Fs Valuation or $2,000 Signature of Auditor Date signed STATE HMI.3tes 12'1 s41.1 TILANt5RwKV 31A &IMO,'ED BY STATE BOARD Or VvnLL•TS.mx FILM-WEED BY nn DEPARTNEYr of LOCAL rovt'A mr FINANCE IC 6-1.1-raa Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As die receipt of this deduction becomes _ more beneficial,there is more incentive than ever for homestead fraud Homestead fraud causes higher In bills for all:therefore. • HEA 1341-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recehe the benefit and to provide additional identifying information necesary to allow county government to better monitor homestead filing-This information will be kept confidential and can only he 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 Bates, Jerry R/ Martha S Hwy 41 N Ilazleton IN 47640 182 Jerry R/Martha S Bates R 1 State Parcel Number Le°al Description Hazleton IN 47640 26-05-06-100-000.313-018 010-00313-00 PT LOT 1 6-1-101-017 AC This form MUST be returned to County Auditor's office. Please do NOT send this form back with your tax payment to the county treasurer. PART 2: TAXPAYER INFORMATION Owner I First Middle Last cSetzszti •itg Address(numbror and street,city,state,and ZIP code) ® Same as property address 7035 41. as. //we/ 9/ , t7/70//r0tii zu. y76vo Spouse First Middle Last /YAeT/-I4 Sue blies Mailing Address(Number and street,city,state,and ZIP code) ®Same as property address 7035— N . U . JO t/ c4 7-4Qz7SToA) . 776e-10 -` - - �—'-- --- . 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 ignature Date PART 4:ADDITIONAL INFORMATION •