HomeMy WebLinkAboutHomestead_Hurt (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5173 (R614-03)
Presor(bed by the Department of Laval Government Finance
INSTRUCTIONS: See roverve &to brfi5p iubuctions.
FO RM rV
� YEAR
HC10 1
I (We) certify that on the lest day of March, 20
�1 y(We) occupied as our principal place of residence the (ol owing described real property for which a Homestead �r�ii 'pertyy1Tatr'rl is hereby claimed:
(�{wa) owned ❑ Are buying under contract (J U
GIBSON COUNTY AUDITOR
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.
NTR.4CT.;RECORDED' �5. �a_ `•`�+?.�'�.'�"�'!�..��'�'�...�`
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
0 - 7�t�"' _ "..-� : �€,-+ =-sn s�'r.
'3i it7se 'rte M.`.,;.1 , P,ERTXDESCR TION
IC�nty
7ownsNp
T d tnd (dry, town, to )
umber
egal escripdon
; s�., ASSESSOR�USE ONLY
Is the property in question:
eel DroPerty ❑ Mobile Home (LC. 6- 1.1 -7)
If any portion of the residential structure or the d note C ing one (1) acre tun
of the property unitized to produce income. (fla�at 16117
at y wrrounds that structure is used to produce income, describe the use and portion
3%9V W- - 10.2bWP MOVE IM bWNE6 &; , CLAIMANT;IN'OTHER`COUNTIES
County Township
County Tmnship
hereby certify the above statements are true, correct and complete.
ure of clai a
Address (number and street, city, state, coal)
13 c x (o E Ta.--u (tv. I rJ 6.6
; s�., ASSESSOR�USE ONLY
�'-
ASSESSEDVALUE
"HOMESTEAD'`
'"NO -RESIDENTIAL
r-
VALIIEz
KAT1100 °A OFlT1/
? VALUEt"
c !VAL-UEX'� -'
Land not exceeding 1 (one) acre immediately
v
surrounding residential improvements.
S�'
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)-r)r`�
r c r .+-
"- `tsar
Residential Improvements or Annually
rai
Assessed Motile I Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
�-. zaiT�SA�M.c�s7� `�n- '``- STANOARDAEDUCTION ALLOWAIICE
20 Pay 20_
Lesser of 112 Homestead $
valuation or 535.000
Signature of Auditor Date signed
•
.satr r n0.N.J V+IR.t I1 JRFANtER mRM TS-tA
♦PPRm'Eo BY st$TE BOARD°M\?t'.TS._n• PAE.4R®WD BY THE DEPARTYfc rri LOCAL rGE0.W.Q.T ra:n.Y[E r•11--r-.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 net for homestead fraud Homestead fraud causes higher tat bills for all;therefore.
• HEA 1343-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information nece,ar v to allow county goermmenn to better monitor homestead
filinio.This information will he kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will the this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Proper Address
Hurt, Brian K
RI Box 65
_ Patoka IN 47666
164
Brii an K Hurt
602 Mohican State Parcel Number Legal Description
PATOKA IN 47666-9007
\Ia1\iIIttL1 II II IIHILIttlltttllttdtttllLtLttltlttII 1 26-04-25-400-000.603-020 HUDSON FARM EAST 16/17
/ __ _-- -. ___ .__ _
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 c Middle Last
3rfa n ,k'-/h 1-1 ul f
tg.Address(number and street,city,state,and ZIP code) 12-Same as propene address
(00 . 440 /I(Caki . Dr. PG -F-okq, ! A . X7616
Spouse - . - - First "'
- . Middle - Last
Mailing Address(Number and street,city.state,and ZIP code) • C ❑ Same as property address
r •
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(phrase specify in Pan*below)
sine
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.
Ow ignaure Date
• Slunature Date Telephone l
. ( /
-: - - -, PART 4:ADDITIONAL INFORMATION a '°,_u P ,