Homestead_Lewisf RI
CLAIM FOR HOMESTEAD PROPERTY TAXr
y "!3 CREDIT /STANDARD DEDUCTION '
State Form 5473 (R2 / 5 -92)
INSTRUCTIONS: See reverse side for filing instructions.
W YEAR
F R _
HC10
` e% _ 993 '
I (We) ( )J "e- 4; {f,(�� `��a certify that on the 1st day of March, 19_
occupied as our principal place of residence the following described real property for which a Homestead Properly Tax Credit is hereby claimed:
(We) owned ❑ Are buying under contract -
❑ Have a beneficial interest in the entity that is liable for the properly taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED
It buying on contract. Fee Simple owner's name -
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County -
Township
Taxing di rict (city, tow , t nship)
Township
�eby certify the above statements are true, correct and complete.
Signature of d2filiant
Parcel num r
Legal d ription �
40 /n
0
21Z
If any portion of the residential structure or the land not exceeding one (1) acre that immediatety wr unds that structure is used to produce income, descdbe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
�eby certify the above statements are true, correct and complete.
Signature of d2filiant
Address mber and eel, city, state, ZIP node) /
D.
V '
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Date signed
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 phis line 7)
(6)
1 hereby certify the above is true, Correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor -
Date signed
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
S
Signature of Audi
Date signed
u
57 ATE FORM.MD i2'f.-LED - TRFAA1PEA FOLV 73-IA
&? WED BY STATE BOARD Or AMPUNT5.9 v PUYAIBFD BY nil 0EPARTMME OF LOCAL EAWRYY.TT.T FDtSCE M 4.I.I-22i.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ester for homestead fraud.Homestead fraud causes higher to bills for all:therefore.
0 HEA 1341-2009 requires taxpayer who receive the homestead standard deduction to scaly that they are eligible to reeehe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will he kept emtidemial and can only be accessed by authorized roomy officials.The Ikpannmt 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
Lewis, Steven K/Delaine Sue Lewis
3rd SF
Hazleton IN 47640
1245
Steven K Lewis
210 W 3rd PO Box 235 State Parcel Number Legal Description
HAZLETON IN 47640-0235
26-02-59-032-000.120-019 014-00120-00 BR 1ST ADD 90 PT
I t lttlltttitlltrrlrrillt trllrtr ttItlrtlltt itlttt lit tltlltt rill
PART 2:TAXPAYER 1NFOR\IATIOLN
Owner I First Middle Last
/a�0 e SLcR, �-tc) [ S
glIg Address(number and street,city,stale lP code) - -- — — — — —O Same as property uddr ss—---- — . -- - —-
a la Y✓ l.3 SS 41 az le:?n4_ 3J Y76,ctfl
Spouse First Middle Last
(teegsed
Mailing Address(Number and street,city,state,and ZIP code) ❑ Stunt as propeny address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
save
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
C, 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.
Owne ignaiureL ,�t Date \
Spouse Signature Date Telephone
( )
PART 4:ADDITIONAL INFORMATION
r