Homestead_ClaytonCLAIM FOR HOMESTEAD PROPERTY TAX FORM YY. AR
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R2/1 -90)
INSTRUCTIONS: See reverse side for filing instructions.
\10 nFLM .CERTIFICATION STATEMENT
I (We) �� n� certify that on the 1 st day of March , 19 7 U
"' occu �as principal place of reside the foffowin described real property for which a Homestead
F19rty Tax Credit is hereby claimed: I (We) owned ❑ Are bu�dP deco, � t
Have a beneficial interest in the entity that is liable for the property taxes on the properly in,d- thai.0-wdls1 e
❑ property or is buying it under a contract. nn.av
I GVIV 111H1..1 HLUUKUCU
If buying on contract, Fee Simple Owner's Name AUDITOR �
Recorder's office where contracts recorded Record Number T Page
PROPER1Y Utbu
Dumber ,Leg
township)
If any portion of the residential. structure or the land not exceeding one (f) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce income.
11.
County
�
vT.ownshi __-
__County
Township
1989 Pay 1990
y certify the above statements are true, correct and gn hire
complete. _ 7
ddress (Street, number, city; slate and ZIP code) v
19— Pay 19
Lesser of 1/2 Homestead
1
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Otherland
Total land - line (1) plus line (2)
Residential improvements Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
(1)
-
1989 Pay 1990
(2)
1991 Pay 1992
Lesser of 1/2 Homestead
19— Pay 19
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Valuation or $2,500
(3)
Valuation or $1,500
Valuation or $1,500
(4)
(5)
Sjepglttr. f L1LfIlQr
(6)
(7)
(6)
I hereby certify the above is true, Signature of Assesor
correct, and complete
Verifying Action - Signature of Auditor
Date Signed
Date Signed
nrw kin Ann nCr%11e T1nM Al 1 r1WANCF
i l
• . J Iv111
-
1989 Pay 1990
1990 Pay 1991
Lesser 1/2 Homestead
1991 Pay 1992
Lesser of 1/2 Homestead
19— Pay 19
Lesser of 1/2 Homestead
Lesser of 112 Homestead
Valuation or $2,500
of
Valuation or $2,000
Valuation or $1,500
Valuation or $1,500
Sjepglttr. f L1LfIlQr
Date Sign d �•,
i l
SIAM FORM't1*117`15-n1 IAFASUREA FORM i5-1A
APPROVED BY MAIL WWTD OF ATTTIINTI.51. PRISTURED BY tt1E DFPAR1MLNI OF LORI GOVERNMENT FINANCE e61.t-r-$.I
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 incenme than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
I® HEA 1344-3009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recebe the
benefit and to puoside additional identifying information necessan to allow county government to better monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county ofcials.The Depanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Clayton, Phyllis J Che rry ST Fq Patoka IN 47666 /
- -- — -
Phyllis J Clayton
P O Box 46 State Parcel Number Legal Description
PATOKA IN 47666-0046
II III I I II II (I I III I III III 26-04-24-303-000.101-020 018-00101-00 COL DIV OUTLOT 5 PT
1 11 111 1 111 III IF 111 1111 11 1 111 11 1
X
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
QYttjs JeAr) C kyrtop.)-..
— �1),) ::i g A d d r e s s i t u m b tt and street,city,state,and ZiP code) —_ _.—_ --5-Sar..a as prepe.^.y add W es. _._ -_ _—_ _ _—_ __. _
'- 6 C4 a.1 'C4.2cr] si- Qtic—tcx 1I(). 4'1L66=cor{b
Spouse First Middle Last
Mailing Address(Number and street,city,stale,and ZIP code) ❑ Same 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)
sure
. 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 I Signature Date
Spouse Si ere Date Telephone
( )
PART 4:ADDITIONAL INFORMATION
0 .