HomeMy WebLinkAboutHomestead_HartleyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
` State Forth 5673 (8817 -07)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS. See reverse side for filing instructions.
FORM YEAR
lb=0
I(We) that on � _
1 (We) occupied as our d 20
principal place of residence the tot g described real ro rty for which a Homestead Property Taz�d�imed:
I (We) awned ❑ Are buying under contract GIBBON C
' Have a beneficial interest in the entity that is liable for the property fazes on the property and that owns the property or is buying under a contract-
CONTRACT RECORDED..
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
County
Tomship
Taxing district (city, town, fownship)
Parcel 1number 1 !� , / 1W� Leggalldescdption �— D �w ,. ��^� �Isss..the property in question:
Jo`1 l lNr 3 3 V5o W� DVV 39 ❑ Real property ❑ Mobile Home (1C 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately su nds that structure is used to produce inceme, describe the use and portion
. tstructure properly utilized to produce income.
PR6PERTYO1NNED BY CLAIMANT
County Township
IN OTHER COUNTIES.
County Township
I hereby certify the above statements are true, correct and complete.
SI a?r of dal am nt
tens (number / I tpfy, state, ,ZlPcod�1 �WV1/@�Cln, 4 ?6 L(ti
(�
ASSES . •- USE ONLY
TRUE TAX VALUE
ASSESS-ED VALUE
HOMESTEAD
NON-RESIbENTIAL
S
or 43,000 for 2009 pay 2010 40,000 payable after 2012
I
Signature of Auditor
Date signed (month, day. year)
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
-
Other land
Tctal land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
rN
or Annually
Assessed Mobile I Manufactured Homeru
Garage
(5)
Other improvements
(6)-
Total improvements (fine 4 through line 6)
(7)
Tctal value (line 3 plus line 7)
(8)
1 hereby certify the above is true, coned, and
Signature of Assessor
Date signed (month. day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
e
STANDARD
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
S
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor
Date signed (month, day. year)
SIMTE FORM!XMIIL/✓m. MAMMA FORM TStA
..r.RovEO BY STATE aIMRDl1F MTTAN.TS IDw ELF.RNOFDnY nlT DEPARTMENTOr LOCAL rOVERVMITT FTAVCE lc t.1-r-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 ester for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
• r HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to eerily that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
' f,� filings,.This information will be kept confidential and on only be accessed by authorized county officials.The Uepannlent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
APR 9 2010 •
Taxpayer Name Property Address
a. ,/ Hartley, Christian D A
V �a(/� Is O Box 266
GIBSON COUNTY AUDITOR
Patoka IN 47666
112
Christian D Hartley
305 N Main State Parcel Number Leea1 Description
PATOKA IN 47666-9515
Ir1rrllttt ltllttr11rrrl1rr 1rlarrlllrtt tlltlttrtlrl rrtlirrltrtl 26-04-24-304-000.333-020 01&-00333-00 COL DIV 39/40PT
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
erg Address(number and street.city,state,and ZIP code) ® Same as property address
�✓ A'itt/A/ s'- ,#.7OK4 /,V 14776O
Spouse First Middle Last
Mailing Address(Number and Street.city,state,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 Pan 4 below)
sox
PART S: 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 09 : may be liable clack taxes and substantial financial penalties.
Owner I� Date
Spouse Signature Date Telephone
( )
PART 4:ADDITIONAL INFORMATION