Homestead_Littlepage`II
I
CLAIM FOR HOMESTEAD PROPERTY TA.
CREDIT /STANDARD DEDUCTION,
State Form 5473 (112 15 92)
INSTRUCTIONS: See reverse side for filing instructions;
FORM YEAR
HC70 4
F.I I
- - " _ _ _ 1 st day of March, 19��
`spied as our principal place of residence the following des ibed real pr erty f which a Homeste��� is hereby claimed:
LJ i tvvej 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 property or is buying under a contract.
CONTRACT RECORDED - - -.
It buying contract Fee Simple owner's name - -
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County
Township -
Taxing district (city, town, township)_ _
Parcel number
�/y� �Q
�`..hrV.r� 0 `oo
Legal description
-
It any portion of the residential structure or the land not exceeding one (1) acre that immedi , ry surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
1
!fy the above statements are true, correct and complete.
Signature of claim ,y(�
(2)
-
Address (number antl street pry, Mate, ZIP code)
/ 3�
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(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 p4/s line 7)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
'
Date signed
'' -action - Signature of Auditor
Date signed
19_Pay 19_
Lesser of 112 Homestead
Valuation or $2,000
STANDARD
S
-Nin alure oIA of I � I Date signed
STATE FORM 51569(Rir-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT 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
uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s dard 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.
PARTI: PROPER 1' INFO ION
Tasparer Name Property Address State Parcel Number Leal Description:
Mischelle Littlepage 119 E THIRD ST
26-02-59-032-000.008-019 E ENLG 54
HAZLETON IN 47640
Complete and return to: I®IIINIMIE HOm®�®01111111130111111IIDm®�
GIBSON COUNTY AUDITOR, 101 N MAN PRINCETON IN 47670 LL
.. _ PART 2:TAXPAYER INFORI%IATION
Owner 1 First Middle Last
MI - 4 N cI etLun ? , n nto
Mailing Address(number and street.city.state and ZIP code)
ISame as property address
-
IK First Middle Last
Mailing Address(number and street,city,state and ZIP code) Same as properly address
Social Security Nmmber(last 5 digits) Diner's License/State ID Number Oast 5 digits) Sae Other(please specify in Part 4 below)
•
- - • PART 3: CERTIFICATION- a -
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 I Signature (� Date
,
Spaise Signature Date Telephone
(. . ) - -
- PART 4:ADDITIONAL LNFOR,I _
IATION .
� IL �
• . _
CIBCOM C lIINTY AIIfITfR