HomeMy WebLinkAboutHomestead_PierceCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (8215 -92)
INSTRUCTIONS: See reverse side for tiling instructions.
FORM
HC10
UTT U T_%
YEAR
CER14 I ATION STATEMENT
I (We) certify MARn te3 sq@ pf March, 19_
I (We) occupied as o p incipal place of residence the following described real property for which a Homestea Property Tax Credit is hereby claimed:
E) I (We) owned C3 Are buying under contract -
4YU
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that own
rivact.
, 0 N D ITOR
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTI N
Court
Township
Taxing district ry t own
ip)
—/
U(XJ W
pji
-
Sasg1Tc
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Sig lure of claimant
ereby certify the above statements are true, correct and complete.
)
t
Address (number and street, city, state, ZIP code)
n
t
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other 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 Assesor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead $
Valuation or $2,000
Sig, a e of A
aor
Daty@igned
SIAM UORM!Jyw iret fort MEASURER FORA ZIA
APPROVED BY 5rsrE BOARD OF Arr"R:N15_pv PRESCRIBED BY TIE DEPARrx104Tcw LOCALr VEILNNIFNT MANCE IC4-I.1-224.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sundanl deduction.As the receipt of this deduction becomes
• more beneficial.there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifyine information ne es ry to allow county government to better monitor homestead
filings.This information will he kept cant:dentfnl and can only be accessed by authorized county officials.The Depanment of
Local Government Finance aill use this information to create tools that will help county officials eliminate homeacad fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Pierce;Roy/Lela Kay
P 0 Hox 237
Patoka IN 47666
169
Roy/Lela Kay Pierce
205 West St State Parcel Number Legal Description
PATOKA IN 47666-9514
I t��rtt�r��rrr�itrt��tt�t�rrritittttiititt���tr tr�t�tirtti� 26-04-26-202-000.578-020 018-00578-00 PTN NE 26-1-11 .5258 AC
rit
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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
t�� 1
\ R.J. Q fRD
mg Address(nu�-r'and street,cityy,,l,state,and ZIP code) -�- 11 \—_ o 0I I Same�as�property
address
Spouse First Middle Last
\ c 1
O Q A
Mailing A drx(Number and street,city,stale,and ZIP code) Same as pmpem address
CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true and correct and that he or she is eliuible 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 Sign Date
•
r1 PART 4:ADDITIONAL INFORMATION