Homestead_Robb (2)I (we)
.; CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Financ_
INSTRUCTIONS: See reverse side for liliny instructions.
¢.S q i e-
II (We) occupied as our principal place of residence the following described real property for which a
iJ 1 (We) owned ❑ Are buying under contract
FORM YEAR
HC10
a fir'
)
of
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 kty:}
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
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. W ;.P.ROPERTY=DESCRIP.TIUN'.?, "#'Z s'y - `.�?,,: '.F.3,';;.;•: ,: ""^ 9Sa' i`E' -±'n, T?,rt�1i
County
Township
r�NON= RESIDENTIAL .
13{
to
Testing tlislnct (city , to rawrrship)�
:
I hereby certify the above
statements are true, correct and complete.
st!'1s4S.VALUE .`.�
SignatureyI claimant
(`�/'
Address (number and street,
52
i05 state, Z
code)
T:, '
Parcel number
Legal description
Is the property in Question:
e O OZ)
E Et,)Icii
O O 6
[Q- -F%al property ❑ Mobile Home ( /.C. 6-1.1 -7)
If any poltion of the residential structure or the Land not axce
ng one (t) acre that immediatey surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
`#
" ASSESSOR USE ON YF ems
TRUETAXI 5Y
s
County
Township
r�NON= RESIDENTIAL .
13{
County Township
I hereby certify the above
statements are true, correct and complete.
st!'1s4S.VALUE .`.�
SignatureyI claimant
(`�/'
Address (number and street,
52
i05 state, Z
code)
T:, '
�e T Pb
`#
" ASSESSOR USE ON YF ems
TRUETAXI 5Y
s
ASSESSED VALUE
,
''"HOMESTE —Wi'
r�NON= RESIDENTIAL .
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�UE`F�.;.x..
;AT 700Ye.OFTTV.t
st!'1s4S.VALUE .`.�
a DTIA .
_ ffrly: '�VALU.E- .'rocs`YR
Land not exceeding 1 (one) acre immediately
au err
surrounding residential improvements.
Other landq
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
s- ra sx
ro�w`u�d c''C�
� SQ
Residential improvements or Annually
Assessed Mobile I Manufactured Horne
Gara e
Other improvements
(6)'-
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plea line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STATE FORM!IM11C1,-..NI it!pe1:lrI FORM 1IA
kPPROVED
TO HOMESTEAD P PROPERTY OWNERS ''
A
Gibson County Auditor
101 N Main
PRINCETON IN 47670 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 e■er for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
• HE.\ 1344-2009 requires taxpayers who remise the homestead standard deduction to verify that they an eligible to recebe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing..This information will he kepi confidential and can only Na accessed by authorized county officials.The ISepanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead &mid.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Leslie, Lana
-ID 502 N Washington ST
fl-I V Ilazleton IN 47640
Lana Leslie Rob b
502 N Washington ST State Parcel Number Le2a1 Description
Hazleton IN 47640-8801
11111111111111111111111111111111111111 fin 1 1111111 26-02-49-101-000.182-019 014-00182-00 E ENLG 105/106
V
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
3_
1e5//e - 'lob b
erg Address(numbci niid tictt,city,state;and ZIP code) - - — —-- - - 'E:65fne as property address — - ---- — —
50i Wa5Alnf roit if #21. �e.ro'n �,41 97G, S'O
Spouse First Middle Last
b0YI R D 6
Mailing Address(Number and street,city,slate,and ZIP code) Epmne as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
bc- ll s� N 95 Ste
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 Signature Date
PART4:ADDITIONAL INFORMATION
•