Homestead_BlaizeCLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION HC10
Stabs Form 5473 (R7 I 5-M
Presorted by tire Depeotmeril of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) K J iD M J—� 'L-' untidy oAjjhw1sWcf March, 20
J(We) occupied as our principal place of residence �th&Allowng described real property for which atomestead Property Tax Credit is hereby claimed:
)(We) owned ❑ Are buying under contract ,JUN 0 8 2007
.Awe a beneficial interest in the entity that is liable for the property taxes on the property and that o%vns the property or is buying under a contract
If buying on contract, Fee Simple owners nome
Retarders ofke Where contact is recorded
Record number I Page
wm- 7". PROPERTY. DESCRIPTION &.*
County Township
'ASSESSED VALUE
Taxing district (city. town. townstdio)
Legal description
WFQ-S�-933-09 ) ISO -019
Is the property in question:
1 ❑ pleat pop" ❑ Mobile H.. (LC. 61.1-7)
of Ne portion of t n Land not exceeding one (1) acre that immediately surrounds Olat structure is used to produce income. describe the use and portion
property utilbed to produce hrmrne. - C-6 MD- 33+10 2sPc
County
certify the above statements are true, correct and complete.
'w (number and 3&wt city, state, Zto code)
county
Township
1 V
on ASSESSOR USE ONLYN
UEMAX�.
'ASSESSED VALUE
"HOMESTEAD
,
-f-A-NON4;tESlDENTlAV-,
OMP
'I"NALUE,
4
Land not exceeding I (one) acre immediately,
surrounding residential improvements.
2
Other land
(2)
Age
—N M
Total land (lima I plus line 2)
(3)
ng
( 4)
5,
Residential improvements or Annually
Assessed Motile! Manutactized Home
Garage
(5)
X.
Z p�
'A
Other improvements
(6)
W
Total improvements (rare 4 liftrottgh Eno 6)
(7)
TcW value (line 3 plus ffne 7)
(8)
I hereby certify the above is true, correct, and
signature of Assessor
Date signed
complete.
Veriyng action - Signature of Auditor
Date signed
I
20_Pay20_
Lesser of 12 Homestead
Valuation or $35.000
Signahze of Xdftr / V 1 A JA I Date signed
.MATE FORM.1)K,R'%1M1 TREASURER JOAN 5-IA
•PP IOW EP PYsIktE BOARD OFMYYR NTR mM PPIsERtam BY THE PEPAATMr-Yr(f LOCAL s1vBtNMFNT Fe(A''CE IC lt.lrf.t
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 the receipt of this deduction becomes
� more beneficial.there is more incentive than e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
�' HEA I$44--3009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
1 filings.This information will he kept confidential and can only he accessed by authorized county ofichds.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Blaize, Diane -
Evansville IN 47703
270
Diane Blaize
417E 2nd St State Parcel Number Legal Description
HAZLETON IN 47640-8830
IIIrnIIrriIIIIttiIiIIIltrrlirl,ItulmilIII IIItruItiIlII 26-02-59-033-\0000/.150-019 014-00150-00 PT MD 331-10.25 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
— _ Dlar ( J �L1 � �Glv —u
lip Ig Address(number mid street,city,state;and ZIP code) — - -- Same as property address
Spouse Fir Middle Last
n 8� - �'B „, Q
n_- Qom`
Mailing Address(Number and street.city.state,and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
swe
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 1 Si age _ Date /
Spouse Signature Date Telephone l
PART 4:ADDITIONAL INFORMATION
S