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Homestead_EllisCLAIM FOR HOMESTEAD PROPERTY TAX FORM CREDIT/STANDARD DEDUCTION HC10 State Form 5473 (R614-03) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse side for filinq instructions, I (We) A MJCf ( K-XX-U certify that on the I st day oi-Aarch, 20 I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed: 1 (We) owned El Are buying under contract L - '�/ / GISS01,; d0j\ �' -UL) '6� for the property taxes on the property and that owns the property or is buyin'g u�der­a contract. Have a beneficial interest in the entity that is liable ONTRACT.:RECORDED If buying on contract, Fee Simple owmer's name Reoordees office where contract is rewrdod ��mmnbe, Page "-STAN6ARE).DEDUCTION"ALILOWANCE 20—Pay2O_ Lesser of 11:2 Homestead value S35.000 F Oro, Date signed ROPE RT,-Y -6E S C RWT11314 County I hereby certify the above statements am true. correct and complete. Twmship Address(n bar and street, city state, ZIP code) Taxing cfiM�� W" W Permit Leg a '9HB—MrSIA —1 W I th m uestion: 16-op R it property El Mobile Home (I.C. 6-1.1-7) If my lon of the residential structure or the land not exc4-ding of the property utilized CrZ307 7-OD I one (1) acre that immediatety surrounds that structure Is used to produce Income. describe the use and portion "-STAN6ARE).DEDUCTION"ALILOWANCE 20—Pay2O_ Lesser of 11:2 Homestead value S35.000 F Oro, Date signed County Toomship County nship I hereby certify the above statements am true. correct and complete. ign ure of c I I Address(n bar and street, city state, ZIP code) - R / &S,/ 1410 0-1-e /-D.,i IAI W7 W" W J-20TINE T ASSESSEDYALUE '9HB—MrSIA 9,®RE,�WKNON-11 0 V'ALT ANIN E Nat mjowoFixi-v� VQ Land not exceeding 1 (one) acre immediately surrounding residential improvements. Otherland (2) A Toal land (fine I plus line 2) (3) Dwelling (4) MEN '151k Residential Improvements or Annually Assessed Mobile I Manufactured Home Garag� (5) Inal - ' f4 czi Other improvements (6) *- ME-- NISSAN Total improvements (line 4 through line 6) (7) Total value (fine 3 plus Me 7) (8) I hereby cerfify the above is true, correct, and Signature of Assessor Date signed complete. Verifying action - Signature of Auditor Date signed "-STAN6ARE).DEDUCTION"ALILOWANCE 20—Pay2O_ Lesser of 11:2 Homestead value S35.000 F Oro, Date signed • snit rotN!,sn ot: .., r4FA5I:LFA!OtM11A .AITROVEn BY STATE&iRD M AMOUNT t MY PLEXAfnWD BY nit bEPAATMEYT OF LOCAL 00VIRNMCNT FINANCEEWVI.I^J.1 Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS PRINCETON IN 47670 Individuals and married couples arc limited to ore homestead standard deduction.As the receipt of this deduction becomes more beneficial,there is more incentive than ever for homestead fraud.Ilomeste:ul 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 recene the benefit and to provide additional identifying information neees ry to allow county goverment to better monitor homestead filings.This information will he kept confidential and can only be accessed by authorized county officials.The De annienl of Local Government Finance will uxe this information to create tools that will help county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION Taxpayer Name Property Address Ellis, Chad A/Katie L ItI Hazleton IN 47640 209 Chad A Ellis 1318 E 870 N _ _- - - - __ — - - -State-Parcel-Number--- - - - tegal.Description- - - - Hazleton IN 47640-9248 �t�tt��ttt�t��rr r�rr���rrr�r�rrrt�t�t�rr��Et�tt tt���t t�t�tt r�� 26-02-58-033-002.347-018 010-02347-00 PT MD 3311012.05 AC X PART 2: TAXPAYER INFORMATION Owner I t • First Middle Last (, h Midd ad- A Eilis •nc Address(number imd street,city,state,and ZIP code) - ' Same as property addr s — -- J jig E 8 -70 N )-Icz z Imo" I N 471040 Spouse First Middle _ Last Kee, L- L// i Mailing Address(Number and street,city,stale,and ZIP code) ® Same as property address 13-) g 276- nJ - -)-{a 2/41 - - - - - 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 unlawfully,he or she may be liable for back taxes and substantial financial penalties. Owner I Signature Date •