HomeMy WebLinkAboutHomestead_Timberlake (3)CLAIM FOR HOMESTEAD PROPERTY TAX ,
CREDIT /STANDARD DEDUCTION '
State Form 5473 (R2/5-92)
INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT
FORM YEAR
HC10
�I (We) _ ( r - certify that on the iCIZIJ c�rANfY®
) occupied as our principal place of ence the oil wing described real property for which a Homestead Property Tax Credit is hereby claimed:
Li I (We) owned ❑ Are buying under contract - •�/n�
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property is ixtd�t act.
- CONTRACT RECORDED - -
If buying on contract, Fee Simple owner's name - - -
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
''
PROPERTY DESCRIPTION - -
Counly
C9 6,1
Township
Township
Taxing district (pry, town, township)
Par el number
6 ►y - -oo
Leg de ription
X
a� Rdd
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrou ds hall structure is used tj produce income. describe the use and portion
of the property utilized to produce income. -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
HOMESTEAD
VALUE
County
Township
seby certify the above statements are true, correct and complete.
Valuation or $2,000
Sjgna(yx�e of claimantt
v nd street, city, state. ZIP code) A\s (S beCa_
ST fm) q76
40
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
Sig a of Auditor
Other land
(2)
is Iq s�
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)
(g)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Wing action - Signature of Auditor
Date signed
- STANDARD DEDUCTION ALLOWANCE
19_Pay 19_
-
Lesser of 112 Homestead
S
Valuation or $2,000
Sig a of Auditor
Date signed
is Iq s�
SIRE RANI!Mt. f-trn IPEISURIR FORM TS-IA
.\rrKT'E,BY GI NPnnrnmrxm'rt_]/N ParPBW BY Mt DEPARTR"lr Of LOCAL oovr .erwr f PA\CE IC4I.I2Z-F.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples arc limited to one homestead slandani deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ever for homestead Gams 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 eligible to reeene the
benefit and to provide additional identifying information necessary to allow county government to better monitor hoes ssrcad
filings.This information will be kept conlidauial and can only he acre_seal 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.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Timberlake, Ronald B/Judy
505 Can ST
Hazleton IN 47640
148
Ronald B/Judy Timberlake
505 Call ST State Parcel Number Legal Description
Hazleton IN 47640-9010
Ir1nn 11nrn1n11tnr1nn111nrn1n 1nt 11 26-02-49-101-000.146-019 014-00146-00 BR 2ND ADD 3 PT/4(5
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
rrd; i . F i, �e r l4 �_
ng Address(number and srrei t,city,state,fu-id ZiP"eodc)— 0 Same as property address —— - — - — —
f5os eau— s-eree & —
- / r , ,
Spouse First Middle Last
8CCeQ l 5 `CyJI.
Mailing Address(Number and street,city,stale,and ZIP code) ❑Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sn¢
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 1 Signature ® Date
S' se Signature Date Telephone r l
PART 4:ADDITIONAL INFORMATION
Wale