Homestead_Douglas (2)CLAIM FOR HOMESTEAD
CREDIT/STANDARD DEDUCTION PROPERTY TAX
State Form 5473 (132/5 -92)
I6
INSTRUCTIONS: See reverse side for filing instructions.
1
A n
YEAR
CERTIFICATION STATEMENT
16 1-4 GIBSON COUNT
I (We) certify that on the 1 st day of March, 19_
I (We) upied as our "ncipal place of res d nce the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
❑ Have 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 owners name
Recorders office where contract is recorded
Record number
Page
" PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
Parcef number
- 10-E.b
Legal descriptio
It any portion of the residential structure or the land not exce ding 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
reby certify the above statements are true, correct and complete.
ignatu claimant
tl es number and street, city, sret. ZIP code)
"/ fox & -,9 L n� 4f la
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements"
Otherland
(2)
Total land (line 1 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 Assesof
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
$
Valuation or S2,000
Signature of Auditor
Date signed
'skiE FORM!):MUC'/r+N, rhEASUann FOAM 79-IA
APPBP'LD BY SITE B •PO Of ACODIA1t.9v PIFSA®m BY n6 DEPAA1%E OF LO:LLOOVELMMQ.'r FDSANcEN'LI.1-:_4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and tarried couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
mom 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 reeene 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 count'.officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION -
Taxpayer Name Property Address
Douglas, Jerry D 3 loll t
Steelman Chapel Road
Patoka IN 47666
274
Jerry D Douglas
State Parcel Number Legal Description
Patoka IN 47666-9102
�tlttllttrltillllllltr��ttlllItrtlllrt�t�trt��r11111
26-0558-01v^1-/000.210-018 010-00210-00 PT MD 111-102.0001 AC
•ttttt11I1
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 I Last
J eery Uon uc ^ C
•ng Address(number and street,city,state,and ZIP code) ® Same as propeny address
31A E. S4eelrnan. Rd. 11-acoka 11'1 41 it La Ca
Spouse First Middle Lan
Mailing Address(Number and street,city,state,and ZIP code) Same as propeny address
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Sate
- CERTIF1C 'i'l N -
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.
w '
O atlue Date
Spouse Signature Date Telephone
( )
PART 4:ADDITIONAL INFORMATION