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Homestead_MoyerCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR CREDIT /STANDARD DEDUCTION HC10 ` State Form 5073 (11817 -07) Prescribed by the Department of Loral Co emment Finance �� INSTRUCTIONS: See reverse side for filing instructions. ® � ® " ,(we) certify that rsF" 1M Aytol @Arch, 20_ .1 _(,(We) occupied as our principal place of resK6ke the fallowing described real property for which a Homestead Propertty jT�az Credit is hereby daimed: I (YVe) owned ❑ Are buying under contract /� "r� Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the �00butillg V(VgOIp�tred. -CONTRACT • . DI If buying on contract, Fee Simple owners name Recorders office where contract is recorded Record number Page County PROPERTY DESCRIPTION. Township Tamn di frict (city, town I mship) Parcel n ber L des don I 16qe property in 'bon: AT 100% OF TTV Real property ❑ Mobile Home (IC 61.1 -7) If anAj6rton of the residential structure or the land not exceed one (1) acre that immediately surrounds that re is used to produce income, describe the use and portion of theWoperty utilized top income. Brart. ASSESSOR TRUE TAX r AT 100% OF TTV VALUE Land not exceeding 1 (one) acre immediately - surrounding residential improvements. Other lard (2) - - Total land (line 1 plus line 2) (3) Residential improvements or Annually Dwelling (4) ">�r'..i_. " ? • Assessed Mobile I Manufactured Home . - -'° - ; ; Garage (5) .- err. Other improvements (6) Total improvements (fine 4 through fine 6) (7) Total value (line 3 plus line 7) (8) 1 hereby certify the above is true, correct, and Signature of Assessor Dale signed (month, day, year) complete. Verifying action - Signature of Auditor Date signed (month, day, year) zu _ pay 20 Lesser of 12 Homestead Valuation or 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012 $ 43,000 for 2009 pay 2010 40,000 payable after 2012 Signature or Auditor I Date signed (month, day year) STATE FOR.'53569(R/S-10) TREASURER FORM TS-IA APPROVED STATE(WARD OF ACCOUNTS.2009 Rt' PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.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 Sta 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 flings. 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: PROPERTY INFORMATION , Taxpayer Name Property Address State Parcel Number Leeal Description: Marcus S Moyer 802E CENTER ST 26-02-49-101-000.255-019 E ENLG 168 HAZLETON IN 47640 77 pp tI17t7pp77I�tmllD41VLfmn !:p ¢gp Complete and return to: _ I©llOMMEll'U11Ltlff0010 POREILIQ1]lllli]© GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 _ . .PART 2t TAXPAI'ER IN . ' . Owner 1 First Middle Last M A ZO (ft ST -E: U E tkj MOgrR Mailing Address(number and street,city.state and ZIP code) I / Same as property address �, - First Middle Last I •Af b 1_ M j . MOUE"• Mairag Address(nurrter and Street.ay,Nate and ZIP code) 171 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 I Signature Date ' - PART 4:AADDITIONAL INFORMATION • ,i NOV t 5 2012 • GIBSON COUNTY AUDITOR