Homestead_DixonCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
j State Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instnrctions.
FORM YEAR
HC10
- lC7 - ZOO
I (We) 1 y, certify that on the 1st day of March, 20_
1 (We) occupied as our pdr6al place of residence the following described real property for which a Homestead Property Tar Credit is hereby claimed:
❑ I (We) owned ❑ Are burying under contract
Have 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.
��.3s r" yC'` s- �. ".�- 'r_`f'S�`�- �i•�re-'- "`y-'t ,- z,. �' v'. e.' rh' 3 ,g- 'r:=`2CONTRACT'RECORDEDj,:'. ,�-,:;'��,J',P.'.r r � �:' - .s"�.�a �:tT`;;� ;e �. -. � ..w":
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
_._ . _ .__ _ ,�' YS •ef +F -+r - -. y.
-., - s.,.,_,.- e . �.. n✓�i xt �Y.vtZ zy.< -` ,'. =;7 = ': P,ROPERTY:DESCRIPTION e, ^r r :.- k,.:_' . . a- �`'�`I v.�. n:.S`.'Ln c-'..F -tg . (�,. W.
County
Township
Taring dist " 7y, to hip)
Parcel,fwmber
Legal description
Is the property i question:
Real property ❑ Mobile Home (I.C. 6-1.1 -7)
H any 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 the property utilized to produce income.
My.a- PROP.ERTY: OWNED! BYCLAIMANT ;IN.'OTHER000NTIES,,,d.`�: -:�}:
County
Township
County
Township
I hereby certify the above statements are We, correct and complete.
Signature of claimant
Address (number and street. city, state, ZIP code) ,
Ashk
MW
�-'rF"''� "'t"r
''' ASSESSOR,USE ONr Y
TRUE TAX
t >P'ASSESSEDVALUE
F10MESTEAD-
�,,. NON= RESO)ENTL4L:
.
x„x'•' . t`i3`- ��sz,4`��:
i}"�•+- VALUEGr y
e
T:4T 100 / a' OF 'TTV.�^}_,VALUE�•q,VALl1E�#,�;
r .k
t
Land not exceeding 1 (one) awe immediately
)s�'- t"'.-�'t'..> -C" ir4-Z, �
surrounding residential improvements.
,� ``06
Other land
-
(2)F+,
Total land (line 1 plus line 2)
(3)
Dwelling
(4)+�°k,�'-
=.F >`i
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
t �, m s
Other improvements
(6).'',
jg
Total improvements (line 4 through line 6)
(7)
Total value (fine 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
:�?�m4m- �- �.k`H..rR`.dh �; .cSTANDARD;DEDUCTION'AC[OWANCE,
20_Pay 20_
TS
Lesser of 112 Homestead
vauatton or 535.000
Signature of Auditor Date signed
STATE FORM 53569(R2/8e9) TREASURER FORM TS-1A I
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICS-I.1-22-8 1
-- P !IMPORT/ANT NOTICE TO HOMESTE'AD'PROPERTY,OWNERS ;
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
0uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
s dard 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.
- ' - P,ARTI: PROPER, Y INFORMATION -_, . -4 I. ' _._
Taxpayer Name Property Address State Parcel Number Leal Description:
Ricky C Dixon 405 N MAIN 26-04-24-302-000.291-020 COL DIV 37PTI3SPT
PRINCETON IN 47670
Complete and return to: IIIIIII01[I11f]IIO[I1lh[ 1111hIIHliDIIIIIIMI]DIEll
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
- PARTglTAXPAY R INFORMATION -
Owner t First Middle Last
Mailing Address(number and street.city,state and ZIP cede)
L I Same as property address
Social Security Number(last 5 digits) Driver's License State ID Number(last 5 digits) state Other(please specify in Part 4 below)
Ow, r 1 First Middle - Last
?,i-y Gaya J D� Vbid
Mailing Address(number and scree city,state,and ZIP code) ❑ Same as property address
PO _i__ 6 x 6 44 rz -.4 443-/v Ain S*4—i4
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) O Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
1 1 ! ! 1 ! 1 1 ! I Stay ------- ----
PART 3:CERTIFICATION -
Fach 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.
Owntt I Signature_ O / p ,/
•eSignatlre Date NO Te�ephn2b11
1 UU L U 1
PART 4: ADDITI6NAL. INFORNIATIOIN 1
.
I RIRSOM COI INTY AUDITOR