Homestead_FrederickCLAIM FOR HOMESTEAD PROPERTY TAX
} CREDIT /STANDARD DEDUCTION
Stale Form 5473 IRS 17-07)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM " YEAR
HC10
IL
I (We) I %-~ 7 VL(..C-iX (/1 `'r L- g L^tif L. certify that on the 1 st day of March, 20_
1 (We) occupied as our principal place of residence the following described real property for which a Homesteady Thy ,('rp"djt is hereby chimed:
QQ /G �. N ia'rJ."F
� I (We) owned ❑ Are buying under centred
nn���� ApUNTY AUDITOR
Have a beneficial interest in the entity that is liable tw the property faxes on the property and that owrGlf $9Mp�4 or is buying under a contract.
COhTRACTRECORDED
If Wyttg on contract Fee Simple owners name
Recorders office where contract is recorded Record number Page
County
Township
I hereby certify the above statements are true, correct and complete.
County
of claimant
cress (number and street city. state, and LP code) - '-4
�1
ASSESSOR •
n
PROPERTY DESCRIPTION
Tomsfup Tmdn9 district (city, ownshi
Pa oc nnumb�r
1p—OQl '1 —S n ] —03 3
Legal description
,al�'3 01(3
Is the property in Question:
I tjjReel property, ❑ Mobile Home (fC 6-1.1 -7)
o eh%portion of the residential structure w the land not exceeding one (1) acre that immediately surrounds that re is used d produce Income, describe the use and portion
of Ne property utilized to produce income.
County
Township
I hereby certify the above statements are true, correct and complete.
County
of claimant
cress (number and street city. state, and LP code) - '-4
�1
ASSESSOR •
• s 1
NON-RESIDENTIAL
AT 100% OF TTV
VALUE i
VALUE
Land not exceeding 1 (one) acre immediately
`; -": •�:., ,
surrounding residential improvements.
Other land
(2)
- -
Total land (line 1 plus line 2)
(3)
9
4
O
Residential improvements or Annually
e
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through Line 6)
(7)
Total value (line 3 pits line 7)
(8)
1 hereby certify the above is true, correct, and
Signature ofAssassor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
LO _ pay 20
Lesser of 12
Homestead Valuation
or
45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
43,000 for 2009 pay 2010 40,000 payable after 2012
SLATE FORM!Mt.iR:/YNI TRENU[F:FORM'MIA
APFRT'ED BY MATE BniRO 1FACCTIO11'AN nn,ST[Bw BY THE OFJARf mST OF LOtA1 ep.^TLI1rN1 FINANCE re t.I-r'-n
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 nee for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1374-2000 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to teethe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be Aryl confidemial 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 I: PROPERTY INFORMATION
Taxpayer Name Property Address
/Ronald L Frederick
Jr
304 S Ohio
Hazleton IN 47640
52
Ronald Frederick L Jr.
304 S Ohio St State Parcel Number Leal Description
HAZLETON IN 47640-8905
Ithtllttrltlltrtlttillrrtlrtldtirt11rrrr1r 1r11r err 1rrlt tllri 26-02-59-033--\J 0(0/0.203-019 014-00203-00 E ENLG 137
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
DA-C.11.4 l.—. I «Gl2NL� f-1 r-
•tag Address(number and street.city,state,and ZIP code) 1 ® Same as property address
—.Si First Middle . .•
Mailing Address(Number and street.city,state,and ZIP code) as property address
lon
Social Security Number sea'_ts Drivers License/State ID Number (last 5 digits) Other(please sprAify in Part 4 below)
_ sex
PAR • —. - - _ - i--
Each undersigned certifies,under penalty of perjury.that the above and foregoing information is true and correct and that he or she is eliuible 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
Spo se Stgnamre Date Telephone
( )
PART 4: ADDITIONAL INFORMATION
•