Homestead_Hall (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM `� YEAR
CREDIT/STANDARD DEDUCTION
State Form 5473 (RS 110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions. 7-1 -T -1 -9-1 T—N
I (we) 'LA -4 -r!" I I a.AX,(,& LOL-1-f I- Uotx certify that onMAVstdaAf EW, 20
1 (We) occupied as our Princibat place of residence the following 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 for the property taxes on the property and that owns the, I de jai,c,"aget.
--'�y4mlv-�,4�-������CONT,RACT.,RECORDED . . . . . . . ...
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
";g '—g - ''W'g
0 kop -ERTY,-dMSCRURT1Cl1N
County Township
County
Township
�ress (number and street, city, state, ZIP
6/02 AJ.�!rST
Tracing district (city, to". township) -Z.
110 F V
P ce uml =r
Le al cleszri
Is the property in ques "
W
A
Other land
Mobile Homo (I.C.6-1.1-7).
If any portion of the residential structure m the land not exceeding one (1) acre
U%A'm lately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
/ I Gi
%., lASSESSOR USE ONLY j
County Township
County Township
I hereby certify the above statements are true, correct and complete.
inahire of claimant
�ress (number and street, city, state, ZIP
6/02 AJ.�!rST
/ I Gi
%., lASSESSOR USE ONLY j
, -TRUE TAX
ASSESSED 'VN
HOMESTEAD.'
ME
Mosglk�!Mg� TR Lr
e
110 F V
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
-c. -. OWINA
j FUM
W
Total land (line I plus line 2)
(3)
Dwelling
(4)
tL
..U0 -NOM
�
®r M
Residential improvements
Garage
(5)
el
-
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
,-.M- STANDARD .'DEDUCTION :ALCOWANCE
4w 20 _ Pay 20_
Lesser of 1/2 Homestead
Valuation or $6.000 $
Signature of Auditor Dartnc6 _6 a
STATE FORM 53569(R31&10) . TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,20P9 .PRESCRIBED BY THE DEPARTMEN'T OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
_ • 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
buses 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 identifying
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!: PROPERTY ,'FO'MA ION
Taxpayer Name Property Address State Parcel Number Leal Description:
William F Hall 107 N MAIN ST 2602-29-200-000.144-019 OLD PLAN 3 PT/4 PT BLK 7
HAZLETON IN 47640
Complete and return to: IMENEI MDO NEffilf�®IWIL'lIlI1lliging m110
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 1 1W 1W11IIln LLII J IIO
- PART 2:TAXPAYER INFORMATION
aner 1 - First Middle last
G( /LL/A M F ,4-4)kLfA/ . Hf4I-I-
Mating Address(number and street,oty,state and ZIP code)
Sarre as property address
/07 l/ fro Id sT 7-/,40“-r0 / _fll 417Gw0
Sv.,..,e First Middle Last
g Mai A- .3/AA./ NAc.L
Mailing Address(number and street.dty,state and ZIP code) L I Same as property address
•
/07 4/. MA,t✓ den ,11-17zttrrda ,L✓ 4174.VC)
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 Signature Date
PART 4:ADDITIONAL INFORMATION
L
NOV 7 2012
GIBSON COUNTY AUDITOR