HomeMy WebLinkAboutHomestead_Whitten (2)tin . CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION rtCIO
State Forth 5473 (R4 / 8-00)
INSTRUCTIONS: See reverse side for filing instructions. it
I_(We) Al r / that
I (We) occupied as our pri pal place of residence the following described real property for which a HomesS�6 MTM Veed, &Tfe* claimed
�i
I (We) owned ❑ Are buying under contract
ave 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.
>'as ----- u. �dCONTRACTj,RECORDED;
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded .. Record number Page
11 W =f. .. .oz's... I I - , -' - n'..�``3"_`
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�Y
P_R_OPERI'Y�DESCRIP.�TION - 'a`'`x` _x._;.. - -
Counry
Tor ship
Taxing district (c
Parcel ber
V —Oo /S7
Legal description
_ 1
_ C /�t //
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. • -
�
fs '-
e �a sue”
gM-21 r ;��i
may- [2 USE'ONLY +i•Y.'
•.�. ,�,-Y- _'�z' •a '..:i E
IN
PROPERTY' „OLNNEDiBYT
OTHER.COU_NTIES^--
County - Township -.
County - Township
I hereby certify the above statements are true, correct and complete:
i ature of daim
S e of Au tw
-
(number et 0; tat
gM-21 r ;��i
may- [2 USE'ONLY +i•Y.'
•.�. ,�,-Y- _'�z' •a '..:i E
TRUE'TAX
r•
_ _-;V �'
IiSSESSEDbVALUE
•p , : o >
A.- T.10010 OFk -T�:T
°HOMESTEAD
t
ROME
e 7 _
NDN�- RESIDENTIAL :.
'r 3 - VALUE�.-D .
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
- Valuation or $6,000
S e of Au tw
-
Other land'
_
(2)
�
fs '-
e �a sue”
Total land (line 1 plus line 2)
(3)
Residential improvements�r,."f
Dwelling
(4)'�,�s�
"'a >_.
"-
Garage
(5)r,
-.,. _
Other improvements
� G x' 1
Trial improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(6)
I hereby certify the above is We, coned, and
complete.
Signature ofAssessor
Date signed
Verifying action - Signature of Auditor
Date signed
�,�_ as a��.sTANt)P.RD.DEDUCTION
ALl:O1NAPICE �y � �: a i
20 _ Pay 20
Lesser of 12 Homestead
$
- Valuation or $6,000
S e of Au tw
DaI n
V/ .o
5151E total 3 W IR:/w0 TP.EASnin FORM 79-IA
•
APPROVED BY STATE Of.1ARD OF Mr(X.N15.:vn PRESCRIBED BY 111E DEPARTEVT(F LOCAL rovERVMrwT EQ:A\CE If 4-1.1-1:4.1
01 N Main n County Auditor
1 IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standant deduction.As the receipt of this deduction becomes
411 more beneficial.there is more incentive than ever for homestead fraud Homestead fraud causes higher tar 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 identifying information necessary to allow county government to better monitor homestead
fling,.This information will he kept confidential and can only be accessed by authorized county officials.The Ikpanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
��
_ .._ ._ ____
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
S4e5 ---". olo-e.T (.4 1,,-r+p3
Ong Address(number and stray.city,state,and ZIP code) l 0 Same as property address
I o 5 S sT Si ? 'b k--4�j, t iI. 6 6
Spouse;� First j Middle Lan
Fe-5 e-5 5 y / -A-N e_ (A)ct .-if P is
Mailing Address(Number and street,city,state.and'Zm code) ❑ Same as property address
i 0 g S. We.5.-r/r. Rct-D CA . to le In
_ . . _ _
- . _.. - ---•--PARTJ:.CERTIF1C�tTION. - - -
Each undersigned certifies,under penalty of perjury.that the above and foregoing informationir tme 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 tax and substantial financial penalties.
Owner/�rII Signature Date (�
APART 4:ADDITIONAL INFORMATION
•