HomeMy WebLinkAboutHomestead_SimmonsCLAIM FOR HOMESTEAD PROPERTY TAX FORM F YEAR
CREDIT/STANDARD DEDUCTION
State Form 5473 (R5I 10-01)
Prescribed by the Department Of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions. -P
ERTIFICATIOWTATHYENJ." J ;?�
I (We)
- oc] P 200%ehfy that on the 1st day of March. 20
I (we) c pied as our principal place of residence the following described real property for which a Homestead Prgperty Tax Credit is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes 04: t�-, pj�—'W Mh�F
C11b �l 14" �jt property or is buying under a contract.
K 50NTRACTRECORDED
It buying on contract. Fee Simple owners name
Recorder's office where contract is recorded Record number Page
sl� , " -0��T - - -- - -- - - - - - - - .1, —
�j �F2V--�;;jPROPERTY�.DESCRIPTIbN'
6�e
County
Taumship
Taxing district (city, to", township)
RL A,
'RESIDENT[
E
n—loncco
L desc
1
Is the property in question:
0 Real property ❑ Mobile Home (I.C. 67.1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediatily surrounds that structure is used to produce income, describe the use and portion
Of the property utilized to produce income.
County Township County Township
I hereby certify the above statements are true, correct and complete. natu of cla,,,9!7
b 0-2� or ]-� 010�Ailli�
as, umber street, city sf
E
°""r is ESSOR ;US 'ON,
R
VALUE
3W
JqLut:
�T100
somumt:5ILM
VAL
RL A,
'RESIDENT[
E
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Otherland
(2)
M<111
OEM`
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
ti
U
Garage
(5)
Other improvements
(6)Rt
Total improvements (line 4 through fine 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1l2 Homestead
Valuation or $6.000
Signature of Auditor
SIVE FORM 53Na t R/NMI IN N{FA FORM 73-IA
AP]Rtw'ED BY STYLE actRO Or1(YIA:.S'r.S,Noe PUYNamD BY rilE DEPARTMENT OF IC CAL GOVERNMENT m:A1'CE IC 6-1.1-224.1
Gibson County Auditor 1
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ever for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
® HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verily that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and can only to accessed by authorized county officials.The Depannrem of
Local Government Finance will use this information to create tools that will help county officials eliminate IomesYead thud.
i; PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Simmons, Marvin R
423 Chem
Patoka IN 47666
100
Marvin R Simmons
P O Box 1 State Parcel Number Legal Description
Patoka IN 47666-0001
I 11till rr.1111$ttlllrtllttlltrtllttrll ,••• 11111111 26-04-24-303-000.332-020 0ie-00332-00 COL DIV OUTLOT 5 PT
-- -
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.
i PART 2:TAXPAYER INFORMATION i,
,..
Owner I First Middle fast
a ,ti g • . �
411kg Address(number and street.city,state,and ZIP code) ❑ Same as property address P
Po . I A� -, , . 4,4 7O$&- 6 C ii A 3 • c°",,jR`0./,_/a
Spouse First - Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
— Social Security Number(last 5 digits) Late
Driver sp s License/State ID Number (last 5 digits) Other(please ecify in Part 4 below)
j PART 3:CERTIFICATION 1,
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 Si acme , Date.'
a c)i,„,..,..;-) fi-,,-,0 Spouse Signature //• Dale Telephone
. v ( )
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tPART 4:ADDITIONAL INFORMATION j
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