Homestead_IceCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Government Finance
FORM YEAR
-Ar"."CERTIFICATION'STNT�9T',,;
071 A;-\ IJ jj_ jj_
I (W 11 111 certify the on t day of March, 20
sour . 1P
occupiev r principal place residence thullowing described real property for which a Hor T Uedil is hereby d,irned:
I (W:)) I F
C� l(We)owned ❑ Are buying under contract rl 6
ow in property or is
4dr_
&4ave a beneficial interest in the entity that is liable for the property taxes on the property and that 'EZ..�_prop a contract.
-C ONTRACT, -RECORDED -;t. =
If buying on contract. Fee Simple owners name
Recarder's office where contract is recorded Record number Page
- - - -' r Y' - " ?J---87W-- .PROPEkTY DESCRIPTIOW2-; W -
County
Tmmship
Township
Taxing district (city, to". township)
P
COIT
no ( q 1-0:)
Legal desc
'onqA
V AL
Is the property in question:
❑ Real property ❑ Mobile Home (I.C. 6-1-1-7)
If any portion of the residential structure or the land not exc ding o a (1)
of the property utilized to produce income. (v 97 W
that immediately surrounds that structure is used to produce income, describe the use and portion
T"198"
pkO0vay.bwNEti7B'� CLAIKU414t Ik _6THER-COUNTIES)
'at�.TRUEiTAX,'ti,�&
County
Township
County
Township
I hereby certify the above statements are true, correct and complete..
Signal of claimant
4 ss x1)Ttcity,;!at!! �IPcodo)
-a C7 K I
4'
ASSESSOR USE ONLY�--`-g .. ... L
'at�.TRUEiTAX,'ti,�&
A SSESSEDYALUE
H 0 1
NON-RESIDENTIAI:
1/6- 0 EXI V
VALLI E
V AL
ip.
Land not exceeding 1 (one) acts immediately
surrounding residential improvements.
Other land
(2)
at
4L
Total land (line I plus fine 2)
(3)
s- 011t
Dwelling
(4)
Residential improvements
Garage
ar Rf- s WX W
(5)
Other improvements
(6)
Total improvements (fine 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
TANDARb.DEDUCTION;ALLOWANCE s - -.
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or $6,000
Signature of Auditor Date signs -ot
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STATE FORM!)w IKrI Yrr rAFASnaEf FORM 11A
Arrrla ED BY[TSTE E t OntMRRi:Ts.:fix ru n is BY ter DERMTCMT(K L(At GOVE10M0.T masat M I-1.1::4.I
10Gibson a t Auditor
1 IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual and married couplm are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e'er for homestead fraud homestead fraud causes higher In bills for all:therefore.
HEA 1344-2009 require taxpayers who remise the homestead standard deduction to verify that they are eligible to reecho the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confid ntial and can only be accessed by authorized county officials.The Depanmmm of
Local Government Finance will use this information to create tools that will help county official eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Ice, Justin W/Jessica
207 N Kentucky ST
Hazleton IN 47640
152
Justin W Ice
207 Kentucky State Parcel Number Legal Description
Hazleton IN 47640-8818
�t�at��ttt�t��l ttlttll�tlrllSltl ltll tlllllttlFll FIr IISFI IF FFII 26-02-49-1011---0 000.191-019 014-00191-00 E ENLG 65/66/67/68
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
U VI a Ie �ce
_ tg.Address Ingather and iIr eet,bity,sate,and ZIP code) - -__ - __ _ - — = ..Same as property-address
Spouse First Middle Last
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5 Sea.
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
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 1Iignature Date
PART 4:ADDITIONAL INFORMATION
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