Homestead_FisherCLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
x State Form 5473 (R2 15-92)
rug
INSTRUCTIONS: See reverse side for filing instructions."�]t�s
YEAR
.. ..,_CERTIFICATION STATEMENT . . ; n.: - -,,r+ n . -�S _ • yzyar .`�� —..
I (We) _ _ _ certify that on tF}EN sCd4y 018&&h. 19
I (We) occupied as our principal place of resi t e the follo ing described real property for which a Homestead Property Tax Credit is wreby claim
Q I (We) owned E:1 Are buying under contract i -` y
%��ig(u
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propucryyor,ls buying under a contract.
- - - .:_... : _ 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 district (city, town, township)
P c nyihtber
6
Legal description
It any portion of the residential structure or the land not exceedi ne (1) acre that immediately surrounds that structure is used to 11froduce income, describe the use and portion
of the property utilized to produce income.
' PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signat a of claimant
1 - Tess (number and street, city. stare. ZlPcude)
(-.,, as
ra,
ASSESSOR USE ONLY '
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
-"
- - ,
VALUE'
VALUE
VALUE
VALUE . -
Land not exceeding 1 (one) acre immediately
-
surrounding residential improvements.
(1)
-
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(a)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
' - - STANDARD DEDUCTION ALLOWANCE'. , -
19_ Pay 19_
Lesser of 1/2 Homestead
$
Valuation or 52,000
Signature of Auditor
Date signed - ^
STATE FORM 53569(R2/5-09) TREASURER FORM TS-IAI
APPROVED BY STATE BOAR:OF ACCOUNTS 2009 PRESCRIBED BY TILE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1-22-S.1
EMI'O ' Mir NO I E`UDHOM AS AO ' '•OP :0 MUM
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 ever for homestead fraud. Homestead fraud
Pauses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who receive the homestead
s andard 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 Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
(JJiJUs PRO P ill Y [i @argis . •
Taxpayer Name Pronern Address State Parcel Number Leal Description:
Donald/Jacqueline Fisher P U Boi 341 26-04-25-102-000.230-020 018-00230-00 SMITHLAND ADD
Patoka IN 47666 / 21 PT/22PT
Complete and return to: (X\/
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
.. r. - PART g3 unsparo INFORMATION i„ :>'
Owner 1 Fest Middle Last
DD4L-V R . , F,sH
Madrg Address(number and street.aly,state and ZIP code) R2Satne as properly address
0 - 3o' C si/ 7RToKA .7r17 $76,66
Middle Last
JAcq UCG+/%or R �,s ner._
Ma3ng Mdress(camber and street city,state and ZIP code) I t,./1 Same as property address
/fir 0 . 3e)-1C 0"I/ ))37v/`4 j 9706 .
- r s T t , .Mi 'l1rrg CERTIFICATION -V: '`*':' ) ?'.-s;a ¢4 :W ; > '. '
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
. f. I ,03 eallOUIRMI,INFORM1ATION - tZ.k <
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