Homestead_Berry (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R817 -07)
Prescribed by the Department at Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
AUG v a 1008
I (We) certify 64, eW*601MT of W52920_
I (We) oclupied as our principal place of residence the following described real property r which a Homestead Property Tax Credit is hereby claimed:
n 1 (We) owned ❑ Are buying under contract
biave 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 ••. r
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
County
Tmnship
1 hereby certify the above statements are true, correct and complete.
street city,
County
ASSESSOR ,
TRUE TAX VAL
s
County
Township
PROPERTY DESCRIPTION.
T strict (city, tun, township)
Parcel number
Legal description
o t
(pc� P
R Is ]the property N bon:
eal property ❑ Mobile Home (IC 6- 1.1 -7)
o arty 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 Ne property utilized to produce income.
o26 - OY- a-� • 300 -coo. -35a -oar
County
Tmnship
1 hereby certify the above statements are true, correct and complete.
street city,
County
ASSESSOR ,
TRUE TAX VAL
s
• s
$
Homestead Valuation
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor
Data signed (month, day. year)
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
,f
Other lard
v .
Total land (line 1 plus line 2)
(3)
welling
(4)
Residential improvements or Annually
-
Assessed
Assessed Mobile / Manufactured Home
Garage
(5)
Other improvements
(6)
Tdal improvements (fine 4 through line 6)
(7)
Total value (line 3 plus fine 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (mm1h, day year)
s • :4 as 0=1 Bill"
Pay 20 _ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
$
Homestead Valuation
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor
Data signed (month, day. year)
SMAtE FORM!!•lalRr I+rvl IltrAS11112 FORM TS-IA
.APPROVED BY Ctlit BARD OF Ali fX,1C.NO* • PtES Br1 BY fir DEPARTMENT(WLOCAL GOVERNMENT FINANCE IC 41.1_a.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 escr 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:tut they art eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filint6.This information will he Lepi confidential and nn only be accessed by authorised 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
Berry, Jon David/Diana L
204 Barnes
Patoka IN 47666
476
Jon D Berry
204 Barnes State Parcel Number Legal Description
PATOKA IN 47666
26-04-24-300-000.352-020 018-00352-00 WOODS ENLG 6OPT
X
• PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
L-_----if)n -0.V (1 2)ec c Ni
�es.Address(number and stet,city;state,and ZIP code) — — — — '0 Same as property nddry — -- --
Po- Sax n5 Pa.+cka- `IL LI7(p(oC
.
Spouse First Middle Last
1)1 a nag L ( n n c r`-�
Mailing Address(Number and street,city,state.and Z}�-bode) 0 Same as property address
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
PART 4:ADDITIONAL INFORMATION