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Homestead_Medcalf" CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT/STANDARD DEDUCTION State Fonn 5473 (R418 -00) u,. INSTRUCTIONS: See reverse side for filing instructions. FORM YEAR HC10 ED I (We) `le- r Q rtity on the 1st d o ''c 20_ (We) occupied as our principal place of residence the following described real property for which a Ho estead 08f retry. ❑ I (we) owned ❑ Are buying under contract ON COU,' AUDITOR �iave 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. } _'', �s,"*.'', dGONTRACTgRECORD if buying on oontrecL Fee Simple owners name Recorders office where contract is recorded - Record number Page I _ - ...- R��.s9 5°' ;'y'°�,��'#, • r- y'- '�-=iT cy tTRUE'TP.JCi"..� 3 N�LiY� - County Townshfp Taxing district (OX town, township) P 1 number ©o Legal description Township hereby certify the above statements are We, correct and complete. It any portion of the residential structure or the lantl not exceetl gone (1) acre #j immediately surrounds that structure is used to produce income, describe the use and portion of the property utilized to produce income. 'Addre I _ - ...- R��.s9 5°' ;'y'°�,��'#, • r- y'- '�-=iT cy tTRUE'TP.JCi"..� 3 N�LiY� Fyn PROPERTY�O . - - BY,GLAIMANTF_IN OTHEit.COUNTIES County Township - County Township hereby certify the above statements are We, correct and complete. ig ture of aimant €t�.Vvaug- 'Addre (number an srre eL dty, stare, ZlP Code) ? !L / G Land not exceeding 1 (one) acre immediately I _ - ...- R��.s9 5°' ;'y'°�,��'#, • r- y'- '�-=iT cy tTRUE'TP.JCi"..� 3 N�LiY� - ,.a.x., -. q f-+ 7UE' ASSESSEDdVQLUE - -..vnc t?HOMESTEAD �a NmON=RESIDENi1,4Lk+- ., °SES V T1D�t D TAY VAIE €t�.Vvaug- 5 jr t..E: .'' ? fi"a ��. Land not exceeding 1 (one) acre immediately (1) ``" surrounding residential improvements. r _a- ✓�,�r_.w�',:. -� Other land 2 <t () k- MOAN— _ c Jir,/ Total land (line i plus line 2) Dwelling L; (4) ' "^ NOR v r Residential improvements Garage 1 '•1 � 4 a� Other improvements (6) A �.q,�� ' :L�•.�.��g'�<4 Total improvements (line 4 through line 6) (7) Total value (line 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 1 I Date signed i . WAD'DT 7 -°, .. :z„ 20_Pay 20_ Lesser of 12 Homestead E Valuation or $6,000 Signature of Auditor Date -- D "V `Y _ STATE FORM 53569(8318-10) TREASURER FORM TS-IA APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARPIENT OF LOCAL GOVERNMENT FINANCE IC6-I-1--22-5.1 IMPORTANT-NOTICE TOIITOMESTEAD 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 Souses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the Mlindard 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. • . PARTt:;PROPERTY INFORNIATION ' Taxpayer Name Property Address Stale Parcel Number Leoal Description: Shawn E/Sausha A Medcalf 205 S MARY ANN DRIVE 26-04-26-202-00054 -020 MARY ANN TERRACE 8 -' PATOKA IN 47666 ��1t�' IDp11 .1�771' uu I�IIII mm pp pppp Complete and return to: I®IIYIIIli111 LIJL1] i 0l�n ll11111 II[O®D]ll1 IH��®VII - GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 PART 2:,TAXPAYERINFORMATION ) . Owner t S c W ri Fust �� w r Middle e d C / /l Last Mairing Address(number and street,oty,state and ZIP code) - c -I/(- 1 Same as property address - - • a - First Middle - Last •Mang Address(number and street city,state and ZIP cede) Same as property address - • 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. Owner I Signature Date ? TART 4: ADDITIONAL INFORMATION Mi • GIBSON COUNTY AUDITOR