HomeMy WebLinkAboutHomestead_DerrCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
J State Form 5473 (RS 110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM 1 YEAR
HC10
31(We)owned rtify thatonthe tst dayof March; 20 ccupied as our principal place of residence the ollowing described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ Are buying under contract
I L O I- ( LUUL
�ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prop e/ or is buyngund e� contra
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded
Record number I Page
-max•_: .- ��„�,r,�- �`_�•��t..
}i _�� -.. m�� �FROP.ERTY.DESCRIP.
County
Toxnship
Taxing disl' t 'ty wn, f nship) , 1 ^^ l
v _
r mbar O ` O ^
U3
Legal description
Is the property in question:
❑ Real property ❑ Mobile Homo (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) aae that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce inwme.
Dyetpigne*`Q
County
Tavnship
un y
Township
hereby certify the above statements are true, correct and complete.
Sig t e cl 'mant
^ddresW an sb t, cdy s e, Z/Pcc e
OTC/
'b'"-m..•- , -
" iASSESSOR USE ONLY - � It
?y
r;
TRUE TAX ,
tiVALl1E�
ASSESSED VALUE
AT.- 100 %OF�TTV„
+HOMESTEAD
A, j,,�VALUEx.�v,�
-� 4- j'NONI RESIDENTIAL
��: ?�VALUE<=z _
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
1
()
� '"y..t,_.�s„s... -,.^r
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(6)
Other improvements
(6)-"'
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
=;STANDARD :DEDUCTI0WAL'LOWANCE
20_Pay 20_
Lesser of 1/2 Homestead
$
Valuation or $6,000
Signature of Auditor
Dyetpigne*`Q
ca
STATE FORM!PM.1A2r WY, THE NtER FORM T9-IA
APPROVED BY MUL aQ1RDOF ACCOUNTS.`nv Pk/SCRIBED BY PIE DEPARTMENT OF LOCAL COVERVMfl'r FINANCE IC 4-1.1.224.1
'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 eser for homestead fraud Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayers oho 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 Depanntmt of
Local Qovcnsnent Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Derr, Debra Ltloshua Derr-Faass
PO Box 872
Vincennes IN 47591
82
Debra L Derr
520 N 150 W State Parcel Number Legal Description
PATOKA IN 47666-9085
I tlt Flltttldlttt lltttllttltittlltt t1r t1Ft1t1rtt 1t 111stt1tt t11 26-04-24-300-000.218-020 COL DIV 2/3PT/10PT/11PT
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Debra_ Louise. Derr
Ong Address(number and sans,city,state,and ZIP code) Same as property address
sae N 'sow Pa}oka , I N 1+d-7(01.06o
--Spexse SO Vs First t Middle Last
TO511i. . 0-ELM aS . ` Rya .
Mailing Address(Number and street,city,state,andZIP code) • ['Same as property address
5a,b N 160v5 ' Palk&, J �. >t71P1t'(n
• . 1;; . ` �—:T' V.-. I
/ � � � PART 3:C RTIFIC, TION ( -t i • 1 '
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
PART 4:ADDITIONAL INFORMATION