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Homestead_Keith�II :l CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR CREDIT /STANDARD DEDUCTION Hcio ` State Form 5473 (R8 17-07) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse side for filing instructions. "(r, I (We) , 00ja 4(4 _ A! fJ1_ i certify that on@i li't 2ayrofNia5r$ch, 20_ I (We) occupied as o r nclpal place of residence"t e following described real property for which a Homestead Property Tax Credit is hereby claimed: (We) awned Are buying under contract ??/a,.,, ra nq eve a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propertrtyy ovr i pr(d (r;T �rtvaG. WOO • ••s r If buying on contract, Fee Simple owners name Recorders office where contract is recorded Record number Page PROPERTY BY CLAIMANT IlNi OTHER COUNTIES County Township County Township RO s Signature of , ant County TavnshiP Toxin di (cif y, own. shiP) S OX-1 I Parcel number al cnp I property in Lion: surrounding residential improvements. II/// /3 �/ � eel Property ❑ Mobile Home (IC 6.1.1 -7) If any of the residential stmcture w the land not exc i g one ( acre t immed ely surtounds that of the rty utilized to produce inmme. re is used to produce income, describe the use and portion �G - 4 - -oss (2) PROPERTY BY CLAIMANT IlNi OTHER COUNTIES County Township County Township I hereby certify the above statements are We, correct and cemplete. Signature of , ant ress umber and street, city, te, end ZlP COdej r s ASSESSOR ONLY TRUE TA - X VALUE . . . . r or 43,000 for 2009 pay 2010 40,000 payable after 2012 Signature of Audits VALUE1 VALUE Land not exceeding 1 (one) acre immediatey - surrounding residential improvements. Other land (2) Tdal land (fine 1 plus Tune 2) (3) Residential improvements or Annually Dwelling (4).� -. Assessed Mobile I Manufactured Home - - - - Garage (5) • Other improvements (6) _ Trial improvements (line 4 through line 6) (7) Trial value (fine 3 plea fine 7) (8) 1 hereby certify the above is We, corned, and Signature of Assessor Date signed (month, day, year) complete. verifying action - Signature of Auditor Date signed (month, day year) STANDARD DEDUCTION ALLOWANCE Pay 20 — 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011 Lesser of 12 44,000 for 2008 Homestead Valuation pay 2009 41,000 for 2011 pay 2012 $ or 43,000 for 2009 pay 2010 40,000 payable after 2012 Signature of Audits Date signed (month. day. YW STATE FORM TENT Ir/ Val TREASUILA FORM TFIA APPROVED BY RATE BOARD Of ACTT CATS.Zoo PAFARFBED BY THE DEPARTE`I70EIOCAI GOVERNMENT FINANCE M<I.1-r4.1 Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS PRINCETON IN 47670 Individuals and married couples are limited o one homestead standard deduction.As the receipt of this deduction becomes more beneficial.there is more incentive than e'er for homestead feud.l lomesread fraud causes 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 Ikpanment 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 _ Keith, Cody A• 203 L 3rd ST Ila>leton IN 47640 267 Cody A Keith 203E 3rd St State Parcel Number Legal Description HAZLETON IN 47640-8910 �t�rr��tr F�F��lll�Ft���t FF�t r�t�F�t FFrt����rrr�� 111111111 26-02-59-033`--0 014-00022-00 E ENLG 111/112/113/114 0000.022-019 • PART 2:TAXPAYER INFORMATION • Owner I First Middle Last Q 1 j.Addres tuber and street;c i t y,smte,a n d code) —'-- - 11-Same as pmpe^.y address—— -- - -- —- - — — Spouse First Middle Last Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as properly address Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below) Sate 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 15nawre Date Spolse� Date Telephone PART 4: ADDITIONAL INFORMATION • .