Homestead_HynemanCLAWFOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
g'"jTCERTIFICATION STATEMENTf�,-----!�
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I (we) 012 certify that on the 1st day of lvlarch, -20
I (We) occupied as our principal place of residence the following d/scribed real property for which a Homestead Frop`0' Te#t �MT!py claimed
l(We)owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the proper�y -buvipouleder a contract.
If buying on contract. Fee Simple crwnees name
�Tlv ,
Record number I Page
PROPERTY DESCRIRTION;.-,,.
County
County
Township
Taxing district (cd)4 town, township)
I hereby certify the above statements are true, con)W and complete.
arcel
M2a)C)'5-V-6D
VW-95— I —I 1 11-904
Is the property in question:
0 Real property
❑ Mobile Home (LC. 6- 1.1 -7)
If any portion of the residential structure or the land not exceeding we (1) am that imunediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to prod" income.
---;��z",qPkOPERTY'(jMED;BYCLAIMANTiIN'OTAER COUNTIEST;*�---
County
Township
County
Township
I hereby certify the above statements are true, con)W and complete.
Signature of claimant
—8 ress (number and street, city, state, ZIP code)
'N
TRUETAX0""
20_ Pay 2O_
HOMESTEAD
�,M--Z%NOWRESIDENTIA
Lesser of 112 Homestead
'YALLJE %
100%
-'AT FFJTV-�'
Valuation or $35,000
S
Land not exceeding
.g 1 (one) acre immediately
Signature of Auditor
a Sig
r :9--1(9 —
—'.0 -Wv
RZ-�
surrounding residential Improvements.
Otherland
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
50 ;r
Residential improvements or Annually
V�KZ-Y: ��tt
Assessed Mobile I Manufactured Home
Garege
(5)
O)hei improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD,DEDUCTION"ALL:OWANCE�k.,..
20_ Pay 2O_
Lesser of 112 Homestead
Valuation or $35,000
S
Signature of Auditor
a Sig
r :9--1(9 —
STATE FORM 53569(FLITS-09) TREASURER FORM TS-I AI
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FLNANCE IC6-1.1.22-8.1
1MI10I &Mr inn=`1UL10 I ,: AD ' ' 0 ' .°i 0 ;
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
•auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers who 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 Department of Local
Government Finance will use this information to create tools that will help county officials eliminate
homestead fraud.
.F ''' -' PART_b: PRE .'TY INFORM WION -,,. - -.s'
TasBarer Name Property Address /1 . L State Parcel Number Loyal Description:
David T Hyneman al 26-04-25-301-000.588-020 018-00588-00 PT SW 25 1 11 1.828
PATOKA IN 47666 I 1 AC
\ '
/ . .
Complete and return to:
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
' E . 4 t cf r. 1, PARTg'if�1 INFOR,MATlO\ - 'P '�
i n
Owner I First Middle Last
DAP1�i TleRy gype,ic '
Mating Address(number and steel,coy.state and ZIP case)
y(Same as property address
Jog Fact,(/-' WRCA/ ,</2 ter 1.91.
rise First -- _ _ - Middle Last .
Maim Address(number and street,dty,state and ZIP code) L. /� Same as property address
1%- „,s ,'. 43, n`.. ;'• , :''PAR BGFR' ,IFICATION' te1p-i s t 4..°45c .3. 'iir '
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 Data
- ';, 4: • DDITIONAL INFORMATION-.. 1 t .. , ..
•