Homestead_Peil-r y
a. E CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5.473 (F12/5-92)
INSTRUCTIONS: See reverse side for filing instructions.
_JO M YEAR
HC10
MAY 1A
"Ne) _ - _ _
Property Tax Credit is hereby claimed:
s
, j I (We) 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 - -
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION -
County
Township
Taxin Istn I , town, wns ) _
C7!/V
Address (number and street, city, stale. ZIP code)
(1)
Parcel number
Legal description
r
_
Other land
If any portion of the residential structure or the land not exceeding one (1) acre t at immediately 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 Gounry
Township
�eby certify the above statements are true, correct and complete. n ,ur f imam
Address (number and street, city, stale. ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Signature of
u or 1(�
s — Date signed —
Other land
(2)
Total land (line I 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 pUs line 7)
(6)
I hereby certify the above is true, correct. and
complete.
Signature of Assessor
Date signed
�Ying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
Lesser of 1/2 Homestead
Valuation or $2,000
$
Signature of
u or 1(�
s — Date signed —
/J
STATE FORM 53568(R.31 8-10) ntSAftRFA FORM 15-IA
APPROVED BY STATE BOARD OF ACCOUMTS YYp Fit MAIM]BY THE DEPARTMENT OF UICALOOVER NMEYF FINANCE IC 61.1-232.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
l OT N. Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
Princeton,IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher sex bills for all;therefore,
g ■ p HFA 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 Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
• MAY 4 2011 PART 1: PROPERTY INFORMATION
C.� Taxpayer Name Location Address
Pell, Randy DNalada D
GIBSON COUNTY AUDITOR 109 E 2ND ST
HAZLETON IN 47640
991
I 111111011111 11111111111111111_1 I�II011]��_IIIDIDI�I111111 IIIflvi 111 11011 Randy D Peil
109
E 2nd
HAZLETON IN 47640-8829
1I1111I1I11II111111'llll1ln•, ,l"II'I'llllltlllll111111t11111t1 State Parcel Number Legal Description
26-02-59-032-000.244-019 OLD PLAN 7PT/8PT BLK 6
•
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
R!\.04 IA HON-- __�__ -- - —
Ov...�r I First Middle Last
•
Mailing Address(number and street,city,state,and ZIP code) Same as property address
/9
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.
thvnry1 aigna c.;:dW Date
INFORMATION