Homestead_FryCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R4 I ")
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INSTRUCTIONS: See reverse side for filing instructions.
1'(We)
I (We) occupied as
7 /' certify
the following described real property for which a Homestead
FORM YEAR
HC10 0 3/0-15
of
l(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 isg4i'll Oun2derlal,w"n
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GONTFOLC�L.RECCLRD V.
It buying on contract Fee Simple mneft name Id GIcIv-
Recorders office where contract is recorded Record number Page
E-Pi;R5PE jYFDff! P, 101
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County
Taxing district
Parcel number
Legal description
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It any portion of the residential structure or the land not exceeding we (1) am that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
P! E
PRO--= -QI T
WPERTY-QYMEP: EW M&W
-W� EUYC —I 1TIN HEWCOUNT E--Xjr-
OR T �d` j 1 ®r MAM
County Tcvmsh p
County. Township
I hereby certify the above statements are true, correct and complete.
Signatut of�qairnant
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Land not exceeding i (one) acre immediately
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surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
'1151 m
Residential improvements
Garage
(5)
W�9- "W
SEEK
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 pits line 7)
(8)
1 hereby certify the above is true, correct, and
Signature ofAssessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 Pay 20
Lesser of 112 Homestead $
A al anon or $6,000
SignatureofAuditor Oat signed
.. -®, •
HAIL FORM,!k^t2`/YM■ • •
TREASURER FORM ZIA
.APPRISED BY"sit mi oOF M PNTS.ym MSRIBm BY TIC OEPMTMENT OF LOCAL GOVERNMENT FINANCE MHLT'-A.I
Gibson County Auditor
101 N Main ' IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sandani deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ever for homestead fraud.Ilomestead fraud causes higher tan 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 identifying information necessary to allow county government to better monitor homestead
filings.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
Fry, Jefferey/ Michelle
206 Mill ST
Hazleton IN 47640
45
Jefferey Fry
206 S Mill ST State Parcel Number Le 2a1 Description
HAZLETON IN 47640-9017
�r�rr��rrr�r��r tr�rr���trr�r�r t�� ���ttr���ttrt��ttr��rr� 26-02-59-032-000.083-019 014-00083-00 OLD PLAN 2PT/3PT/BLK 4
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
J as {` tstr.e.y !-I Vl,^ Fri,
0„,Address(number and street.city,state,and ZIP code) 0 Same as property address
c.
:2OCF —5- 00+L-\ fl'\ t \\ S+f-rct I-1r4,yia+art lr3 1476443
Spouse First Middle ,��' Last
ft)i c:a elk- YY D�Ji?P l`'� y."
Mailing Address(Number and street,city,state,and ZIP code) 9 Same as property address
Si 04 . -, ij5trerr 44711 ?AJ � (" 769 o
_
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 properly. 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 Si attire Date
wU. PART 4: ADDITIONAL INFORMATION
0