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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
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