HomeMy WebLinkAboutHomestead_Evansf YEAR
CLAIM FOR HOMESTEAD PROPERTY TAX W\ FORM
' CREDIT /STANDARD DEDUCTION HC10
State Form 5773 (Ra 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
I (We) A o in aS W Cl A M to k L V dOJ; certify that on the 1st day of March, 20
11 (We) occupied as our principal place of resider the following described real property for which a Homestead Property Tax Credit is hereby claimed:
L Y I (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
ONTR%iCT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
'(: Syr. Y✓ x. r1i�a' !^dP,ROP.ERTYfDESCRIP,TIONrt`,' sr�n'�•3!a'
Coun
T"n'sh*ip\
lY
County Township
Taxing di tact (city, Crown, t
Z 1 E
wnship)
Parcel number
O ( b
LeCqal description r
L— Q S e t—r,) C ul
y�� Is the property in question:
p y �� �g.openy ❑ Mobile Homo (I.C. 61.1 -7)
If any pomon of the residential structure or the land not exceeding one (1) a
of the property utilized to produce income.
e that immediately surrounds that structure is used to produce income, describe the use and portion
ASSESSORUSE ONLYs `
County
Township
County Township
I hereby certify the above statements are We, correct and complete.
Signature of claimant
ran (number and street, city, state, ZIP code)
ASSESSORUSE ONLYs `
'TRUE ?NCi
'
ASSESSEDVALUE
"AT,700%
�`HOMESTEAD�-
INON E' DQetA +i
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Land not exceeding 1 (one) acre immediately
(1)
"1 -; °#',
e,`;
surrounding residential improvements.
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Other land
2
()
5 ° -TP
�._
y ti
Trial land (line 1 plus line 2)
(3)
IT
Yyr
Dwelling
(4)
-- -�.�
.. rte, r+
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t WIN
CCI
#t��u-
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
_
Other improvements
(6)
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(S)
hereby cattily the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Valuation or 535.000
Signature of Auditor
STATE FORM!E'M,R_t fon rnMASURU FORM 73-IA
♦rFRovEn BY STATE BOARD°,n--rn.NS an, prznmm BY Tilt DE?AAnME`TOF LOCAL nMLtsMrT'n FINANCE R'41.1-r-lI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limbed to one homestead saandard deduction.As the receipt of this dalunion becomes
more beneficial,there is more incentive than eser for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
IP HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to remise the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will he cep confidential and can only he accessed by authorized county officials.The Ikpartment of
Local Government Finance will toe this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
—. Evans, Thomas W/Amy L
107 Tennessee AVE
Hazleton IN 47640
26
O
Thomas W Evans
107 N Tennessee ST State Parcel Number Legal Description
HAZLETON IN 47640-8833
26-02-49-101-000.280-019
..`--0 00/0.280-019 014-00280-00EENLG85PT
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
•
-Thomas Wagne- Evans ..
rug Address(number and street,city,state,and ZIP code) VSnme as property address
® ee
l M "le nnQssQe -3\ ya31e-kon -IN InL_a4O
Spouse First Middle Last
AMLI Lynne, E--V S
Mailing Address(Number and street,city,state,and ZIP code) (Same as property address
Other(please specify in Pan 4 below)
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 I Signature Date
PART 4: ADDITIONAL INFORMATION