Homestead_BertramCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2 / 5 -92)
Hsu
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC70
IYUY r U )
LL , y
1 (We) _ Q /.C. certify that on t e 1st day of March, 19
occupied as our principal place of residence the following described re. at property for womestead ro�y T hereby claimed:
(We) owned ❑ Are buying under contract t- ✓- �r!,CI�
�..__� _. .et,_. r�R�
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property o� IS %i under a contract.
_ -CONTRACT RECORDED - -
It buying on contract, Fee Simple owner's name -
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
` PROPERTY DESCRIPTION -"
County
Township
Taxing district (city. town, township)
Parcel num
Leg escription
- w
7- s� is --
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.
(2)
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
aeby certify the above statements are true, correct and complete.
5 tu- clai
ant
Address (number and street. city, state, ZIP code)
ASSESSOR USE ONLY
TRUETAX
VALUE
ASSESSED
VALUE.
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signat a of Autlitor
Otherland
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
�xs
STANDARD DEDUCTION ALLOWANCE -
19 —Pay 19_
Lesser of 112 Homestead
S
Valuation or $2,000
Signat a of Autlitor
ate signed
7
NEME DORM YN OC fl TWO TRFAana.aFORM 11-IA .
APPRrwED BY SETTE EMITRDOI NTT/UNIT 9n PRE%FIam BY THE DEPARTMENT OF LOCAL nova'lMRn FINANCE If 1-1.1-22-1.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard 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.
as
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify 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 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Bertram, Richard Timothy/Angela 6, '(t�
R113ox41A � Qn_}"
Hazleton IN 47640
68
Richard Timothy/Angela Bertram
5603 Old 41 N State Parcel Number Legal Description
Hazleton IN N 47640-9222
Itltrlltttlrlltttlttllltt tit ltrrr lr lr tit lrrlrlll 111 111111 26-04-12-400-001.441-018 010-01441-00 PT SE 121113.415 AC
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
R..LVAr A- 1, flex 4R --
long Address(number and street,city,state,and ZIP code) Same as property address
SLo3 NO CA-\ Oil us 14--ii 41 I tz\e- et) ,1c3 'A 11t,MO
Spouse First Middle Last
ANSe'4 Lyn.) Siec-I-cc
Mailing Address(Number and street,city,state,and ZIP code) 0 Same as property address
Sbo3 t 0c-3A- 0IA L'S 1-\- 1 `II 1IA--i\e\-u►x 7f.. '- l1 '&0
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
unlawfidly,he or she may be liable for back taxes and substantial financial penalties.
-
Owner I Signature Date
PART 4:ADDITIONAL INFORMATION
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