Homestead_Donohoo (4) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
eirP 4a FORM
;�' -y, CREDIT/STANDARD DEDUCTION HC1O • i Rqa_
a;,. ". State Form 5473 (R2/1-90) '
'°° ` INSTRUCTIONS: See reverse side for filing instructions. _ q3
CERTIFICATIeN STATEMENT . - • - •
1 I (We`1.0 �.-_ oprat!► ':��.�• certify that on the 1st.day of March , 19 TcZ
r -
'(We)occupied as our pri .al place of residence the foil ing described real property for which a Homestead
Property Tax Credit is hereby claimed: •� I (We$ owned ❑ Are buying under contract
▪ Have a beneficial interest in the entity that is liable foi the property taxes on th 1.z/1 aritt 1.1 .\ ns the
• property or is buying it under a contract.
CONTRACT RECORD ED
JUL 15 1S9L '
If buying on contract. Fee Simple Owners Name - - 1 s
Recorder's office where contract is recorded . - Record N1�WtUd)T�
PROPERTY DESCRIPTION
ou )/� Township Taxing District ( ' own; to nship)igai,
Parcel Number CS/ Legal Description
001- rosb`1-off YUIJ ) 4 - 3 - 9 p /7(✓
If any portion of the residential structure or the land not exceeding one (1).acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property.utilized to produce income.
- PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
�.hereby certify the above statements are true.correct and —�X(fnature. r�
complete. . /U,&) ) Ct`{\r5
Address (Street. number. city. state and ZIP code) ,
c i
i
</ .\
_
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMES' it iN-RESIDEFI'1AL
'/ / VAP" /
Land not exceeding 1 (one)acre immediately • I / /
surrounding residential improvements (1) _ / / % `7
/
Other land (2) _ 1
Total land- line (1) plus line(2) (3) / '. /
- Residential improvements - - Dwelling - (4) - - - / ,) / /-/ / --
/ ,
Garage (5) i J
t
Other improvements (6) ,,
i i /\ , ,
Total improvements-line(4)through line(6) (7) 'r/ / - /
Total value- line(3)plus line(7) (8) 4. pi
I hereby certify the above is true, Signature of Assesor / jied
correct, and complete
Verifying Action - Signature of Auditor `, Jaie Signed
I
STANDARD DEDUCTION ALLOWANCE
lip1989 Pay 1990 1990 Pay 1991 1991 Pay 1992 19—Pay 19—
Lesser of 1/2 Homestead Lesser of 1/2 Homestead Lesser of 1/2 Homestead Lesser of 1/2 Homestead
Valuation or$2,500 Valuation or $2.000 Valuation or$1,500 Valuation or$1,500
Si at re of Auditor Date Signed ivi
STATE FORM 53569 Q13/]L5) TREASURER W0.M TS-IA
APPAOSTD BY STATE BOARD LF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT;NANCE IC 6-11-22 dl
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 causes 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 indentifying 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 homestead fraud.
PART 1: PROPERTY INFORMATION
Property Address(number and street,city,state,and ZIP code)
6 FILED
State Parcel Number
o?G-cfa-/VC /O29 —OO/ 2, 2. 00/ APR 852014
GIOSON CpUN' n:AUDITOR
PART 2:TAXPAYER INFORMATION
Owner I / First Last
Mailing Address(number and street,city,state,and ZIP code) Same as property address
Spouse First Middle Last
•
Mailing Address(Number and street,city,state,and ZIP code) Same as property address •
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
scte
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, o she may be liable for back taxes and substantial financial penalties.
Owner t Signature j Date
Lad/
Spouse Signature Date Telephone
PART 4: ADDITIONAL INFORMATION
INSTRUCTIONS