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Homestead_Clark� � w a%^ f CLAIM FOR HOMESTEAD PROPERTY TAX diE CREDIT /STANDARD DEDUCTION . .; State Form 5473 (8215.92) eie INSTRUCTIONS: See reverse side for filing instructions. R _. . -� YEAR EB 2 6 1995 CERTIFICATION STATEMENT - I MD4T0R I (We) — _ `�- - certify that o MD. 10R' of March, 19 1 (We) occupied as our principal lace of r ,dence the following described real property for which a Homestead Property Tax Credit is hereby claimed: Q1 (We) owned ❑ Are buying under contract Aave 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. CONTRACT RECORDED If 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 number Legal description ess (number and street, city. state, ZIP code) �1 6 It 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 I hereby certify the above statements are true, correct and complete. Signature c Npant ess (number and street, city. state, ZIP code) �1 6 ASSESSOR USE ONLY TRUETAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON- RESIDENTIAL VALUE Land not exceeding I (one) acre immediately surrounding residential improvements. (1) 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 plis 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 _ STANDARD DEDUCTION ALLOWANCE ~ 19 _Pay 19_ Lesser of V2 Homestead Valuation or $2,000 $ Signature of Auditor Date signed STATE FORM 53569(R2/5-09) TREASURER FORM TS-IAI APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FNANCE IC6-1.1-22-5.1 Ih11iP;Q atimNT;�V ® osij©7ssisi�E>ilkiMU22PRO,PEg aiaYI[OrW�1VE^R pmt • 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 •auses higher tax bills for all; therefore, HEA 1344-2099 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 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. 1'AR44: PROPERtTY.INFORM-WTI-O\ Tasoever Name Property Address 9/7 State Parcel Number Leal Description: Richard Jeff/Julia A Clark RI Box 149-b : 26-05-38-002-002.066-018 010-02066-00 PT SUR 2&3 1 10 Pamka IN 41666� 10.8145 AC C-I-D-12 Complete and return to: GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 "> iSJA.f'.r.,. s .J;'IikinitI3S �i .d4t.bl( 4"n:i3i:S ..w - 5�, §A;Y1,�Yli i. o :tb`. Owner 1 First Middle Last tS CyAr T FFaEy ClLi4 Madng Address(number and sweet,aty,state and ZIP code) I Same as property address 1,356 /✓ T t PPET 46 / i loo/(p 14 7CoL (n =� First Middle Last Jut,-/A /1/5liJ CIL/94k Madrg Address(amber and street,city,state and ZIP code) Same as property address 4350 Al At l PPETT KO R Te3 Atm hi '7(0606 '-tfr .t i - €z pxtis3 iniar mArT10N 1 t _.s,r_ T 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 Signature Date PART ADDITIONAL TIO\:..,;: 4 '';.,' . . :, Q,, FILED SEP232011 • GIBSON COUNTY OR