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HomeMy WebLinkAboutHomestead_McGillemCLAIM FOR HOMESTEAD PROPERTY TAX CREDIT /STANDARD DEDUCTION State Fomn 5473 (R614-03) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse side for riling instructions. OR Y YEAR C110 SUN 3 2005 Wiz" �'-',CERTIFICATION:STATEMENT.�..,�r,.� I (We) (Tk �h nv\, certify that Tn I (We) occupied as our principal place of residence the following described real property for which a HomesteaVSSQ* Q�'redit is hereby claimed: a) 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 property or is buying under a contract. -X *CONTRACT•RECORDED 41'-'V L; If buying on contract. Fee Simple owner's name Recorders office where contract is recorded Record number Page PROPERTY. DESCRIPTION County Ta#nship I TTp district (ady, town, township) CIA ;JT;� Parcel number — ® ress (number and street, City, state, ZIP code) Is the property �Iuasdon: 4�ima� property Mobile Home (I.C. 6-1. 1-7) If any portion of the residential structure or the land not exceeding we (1) acri that immedialely of the property utilized to produce income. surrounds that structure is used to produce income, describe the use and portion iiROPkRTY,,'OWi4EDiBYCLAIMkNTIN?OTHEWCOUNTIES�r�;, County Township County ToAmshlp I hereby certify the above statements are true, correct and complete. Sign may ress (number and street, City, state, ZIP code) W �W MUND PIZ SS LY. TAX TNAL 20 _ Pay 20 HbA' E— STADAQ E X—NOWRESIDENTIAL�,—: Lesser of 1/2 Homestead ��RUE PIZ VALUE Signature of Audi Date signed Land not exceeding I (one) acre immediately 3-4:�)5 surrounding residential Improvements. -'j— Other land (2) Total land (line I plus line 2) (3) Dwelling (4) Residential improvements or Annually Assessed Mobile /Manufactured Home Garage —X� (5) R (improvements (6) :� Total Improvements (line 4 through line 6) (7) Tdal value (line 3 plus line 7) (8) I hereby certify the above is true, correct, and Signature of Assessor Date signed complete. VedWg action - Signature of Auditor Date signed K � STANDARD, DEDUCTION ALLOWANCEt�, 20 _ Pay 20 Lesser of 1/2 Homestead Valuation or $35,000 1$ Signature of Audi Date signed 3-4:�)5 STATE FORM 53569(R315-10) a - TREASURER FORM TS-IA APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE ICS-I.1-22-8.1 IMPORTANT NOTICE TO'HOMESTEAD 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 auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead s • ndard deduction to verify that they are eligible to receive the benefit and to provide additional identifying 4) 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. • PAR I: P'OPER Y INFO_ 'NIA ION Taspawer Name Property Address Stale Parcel Number Leeal Description: Charles R A1cGillem 106 E VINE ST 26-04-24304-000.261-020 COL DIV 73PT/78PT PATOKA IN 47666 _ _Complete.and return to: IIIIIONIII Q MEMED MQmm07LOm©fE11 GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 .. T.T. . .. - PART 2: TAXPAYER INFOIL%IATION Owner 1 First Middle �^ n- - Last Ma 9 Address(mintier and street_aty,stale and ZIP code) 1 s C./-" —as property address - �e First Middle Last LIIlen/ in a21C. . plc 0' '('em Mailing Address(number and strce4 dry.state and ZIP code) me as property address _,`_ , _ ___ 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 PAR-I-4: ADDITIONAL INFORMATION t FILED • NOV 5 2012 cMcnrs...- GIBSON COON I Y AUULTuR