HomeMy WebLinkAboutHomestead_RozikaCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5-92)
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INSTRUCTIONS: See reverse side for filing instructions.
as our principal place of residencojhe following described
J_"FORM
J
A1DITOR�
YEAR
V
-41-n . certify that on the 1 st day of March, 19
which a Homestead Property Tax Credit is hereby claimed:
❑ 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"
It buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
' PROPERTY DESCRIPTION -
County
Township
Taxing district (dry. town, township)
Parcel number /-�
I ^o
Legal description //''
L
It any portion of the residential structure or the land not exceeding one (1) acre that 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 County Township
0eby certify the above statements are true, correct and complete. Signat re claimant
Address (number and street city, state, ZIP code) O
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
- NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Auditor 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 pbs line 7)
(S)
hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
�Ving action - Sgnature of Auditor
Date signed
- STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
"
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor Date signed
t
STATE FORM 53569(R2.13-10) - TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 •• PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICG1.I"-SI
- 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
buses higher tax bills for all; therefore, HEA 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.
- P • I: PROPERTY INFORMATION
the Properts-Address State Parcel Number Leal Description:
Kenneth Rozika 403 t1'ARKANSAS ST 26-02-59-017-000.258-019 PT MD 17-1-10 1.00 AC.
HAZLETON IN 47640
Complete and return to: IMIENHl MIli Ei111Q11m1111O11Q1111 QHEIOII
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
.'m PART 2:TAXPAYER INFORMATION -
Ovmer 1 MIA/IN/El- First Middle Last
h a K% i.s ,90 z i k A
Mailing Address(number and street,aty,state and ZIP code)
I me as property address
.t.—se First Middle Last
Mailing Address(number and street,city.state and ZIP code) Sane as properly address
Social Security Number(last 5 digits) Drives License/State ID Hunter(last 5 digits) Sae Other(please specify in Part 4 below)
PART 3: CERTIFICATION _ . .-, ;__y
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.
Oann I Signature Date
Spouse Signature Date Telephone •
( )
' ', , , -PART 4:ADDITIONAL INFORMATION - l C. 1 . Ill f.\\
- —. R '.,
NOV' 7 2012 .
GIBSON COUNTY AUDITOR