Homestead_SplittorffCLAIM FOR HOMESTEAD PROPERTY TAX FORM -
;;� CREDIT /STANDARD DEDUCTION - HC10
r State Form 5473(R2/5-92)
aS
INSTRUCTIONS: See reverse side for filing instructions.
YEAR
(We) _ _ _ con l thaCt CIlnn the lgt d12w0o7LMarch, 19
�e y c�pet( T1a1:0 dt7r3m
) occ ed grind I place of residence the followin describedreal pr y or which a Homestead Pr y re ereby claimed:
I (We) owned I] Are buying under contract - �/
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns a property-e�s g c tract.
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 di trig city, town, tow hi
Par - um r
Legal descri
i n
Ht r
Other land -
(2)
If any ponio of the residgnbal s(ructure or a land not exceeding one (1) acre that immediately surrounds that ructure is us produce income, describe the use and portion
of )r� ((r�ggty u'.fi3�Ctto -ydycp inm
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
eb y certify the above statements are true, correct and complete.
Signatur claimant r
X
Address (number and street. dry. state. ZIP code)
V
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
Ht r
Other land -
(2)
a s4^ d
_J'7-7
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 pUs fine/)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
� " mg action - Signature of Auditor
Date signed
I
illft�
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
S
Valuation or $2,000
Ht r
of Aud�
or
a s4^ d
_J'7-7
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CRATE FORM WOCF MAMTER FORM oats
.VtMUEI BT[MIE RMMD Of al 1a.Nos r4SCRIBED BY mr DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC.4.1-_r.l
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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 tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are elicible to creche the
benefit and to provide additional identifying information Itecessa to allow county government to better monitor homestead
filings. This information will be kept confidential and can only be accessed by authorised county officials.The Ikpanment of
local Govermnent Finance will uc this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Splittorff, Jeffrey W/Bonita S
117 Tennessee ST
_ Hazleton IN 47640
161 _ . _ —
Jeffrey W/Bonita S Splittorff
117 Tennessee ST State Parcel Number Lesal Description
Hazleton IN 47640-8834
LIttILttIIlltttlttlllttrlrtLltdlttlllJtJtttllltttlLJtl 26-02-49-101-000.306-019 014-00306-00EENLG88
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Tt "I'f'e-y Way rte_ Sp L. I-1-o r 14
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
rg- cq k- 1082_
stale
Spouse First Middle Last
#.10tt( ‘U f_ PL14+0( 4
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
2-1z ice s� -0eizs
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 rIII Signature ��" Date
PART 4: ADDITIONAL INFORMATION
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