HomeMy WebLinkAboutHomestead_JollyR. CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for tiling instructions.
I (We) (4,U a J "� ( `'j certify that on ApRst Bay)OQ*4h, 20
(We) occupied as our principal place of residence the following described real property for which a Homestead Prrgperty Tax Credit is hereby claimed:
I (1Na) 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 pjroy�peRy� .o�r��ls- ibuy�hgu��nd�eil„a�l �lc6ntract.
_L. a-- TY iSi .2Yt. a - - .' r "` + aS'g5. .
'. -. nrn�°- �' sx-. �` ����. �.-' �SieYi.` ��iS�e. W. �'. CONTRACTRECORDED�i�� ,"�Sia`�'.'3`n 2. `:Fg1���.t'�'.`ys. 1... -mac,. ��ti
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
c..
. aP. ROPERTY :DESCRIP,TIONs,'"`$'�.cZ`5''
c V S J -
Township �
Toting tl`11
(city, 711 f� hiP)
l
Parcel number
Legal description
Date signed
Is the property in question:
014
S
'
E3-Real property El Mobile Homo (I.C.
If any portion of the residential structure or the land not exceeding one (1) acre that unmediatety wneunds that structure is used to produce income. describe the use and portion
of the property ubl7od to produce income.
__ _. _ _
g°, �P, fiOP. ERTY, OWNEDBIX ;CLAIMANT;IN:OTHER
_ __. _ _ ..___. _
'COUNTIESi�
County
Township -
County Township
I hereby certify the above statements are true, correct and complete.
Signaaure of claimant
Address (number and street, city, sr' P code)
Date signed
VALUEa
ASSESSOR USE ON' Y �; ry
TRUEvTAXF
ASSESSED VALUE
HOMESTEAD
NON - RESIDENTIAL 4 ??
sr�-" w. iq/;:• s+ :.ii3.._€.r'>:- 's°.i;'�"�•rsra*
VALUE''
SAT t00Yo'fOF� MTV AyrtVAIUEr:�d�'7
Date signed
VALUEa
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile / Manufamned Home
Garage
(6)
r .�
7
ti T
i�.
Other improvements
(6)
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
z
z" �"' a7g5�lx`ST/W DARD'DEOUCTION ALLOWANCE,„
20_Pay 20_
Lesser of 1/2 Homestead
valuation or 535.000
§
Signature of Auditor
Date signed
-13 _
POE RPM 5,51.11C./w't • • TREASnau FORM ZIA
. .ArrMw'En BY PPE IXMRoot M tUrairs Sur ru3RlBmm'PW DtFAR15QVr<F LOCAL Goya-Pulp FR<A5CE M.I.1-resit
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples ate limited to one homestead standard deduction.As the receipt of this deduction becomes
400 more beneficial.there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1334-2IX9 requires taxpayers who receive the homestead standard deduction to verily that they are eligible to receve the
benefit and to provide additional identifying information necesery to allow county government to better monitor homestead
filint_e.This information will he kept confidential and can only he accessed by authorized county officials.The Department of
local Government Finance will u-c this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Jolly, Glenda A/ Diana M
301 Mill ST
Hazleton IN 47fri0
—
Glenda A/Diana M Jolly
301 Mill St State Parcel Number Leaal Description
Hazleton IN 47640-9020
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
1 ,,
_ I) �I An a DQVIOSSe
�Sg Address(ndrnner and street,city,state;and ZIP code) "" - - - -- - - r ul e'm property - — — — — ---
3 n 1 Mt\ Nea,kc -t-oN �1 � i� toLfo
"
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
slate
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 ignanae ./� Date
Spouse Signature Date Telephone
( )
PART 4:ADDITIONAL INFORMATION
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