HomeMy WebLinkAboutHomestead_Hulfachor (3)CLAIM FOR HOMESTEAD PROPERTY TAX
t CREDIT /STANDARD DEDUCTION
` State Foan 5473 (Ra 17 -07)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
W M YEAR
VTOTT
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I (We) certify that on 1 �y4lq�h, 20
1 (We) occupied as our principal ace of residence the lowing described real property for which a Homestead Prp 8WW-''AisP ( IVIdipred;
�I (We) owned ❑ Are buying under contract rS
Have a beneficial interest in the entity that is liable for the property taxes on the property and that ovens the property or is buying under a contract.
CONTRACT ••r .
If buying on contract Fee Simple ownees name
Recadefs office where contract is recorded Record number Page
.• OWNED BY
County Township
RO .
County
Twmship 13jing istrict (city, town, f hip)
Parcel number
Legal description '703 Ac
O / y — � � /
Is the property in question:
I ❑ Real property ❑ Mobile Home (1C 6-1.1 -7)
If ny 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
a property utilized to produce income.
/DD- 00�.�� -v /�
.• OWNED BY
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of daunam
VALUE
F,. VALUE�'
ess (number and sliest, cify, state, and ZIP )
coda
07 Zoo w Z/J- 6
ASSES •-
HOMESTEAD
--NON-RE4D'ENTIAL:-.
Lesser of 12 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation
AT100%OFTTV
VALUE
F,. VALUE�'
Land not exceeding 1 (one) acre immediately
its signed (month, day, year)
r ?.x °. >''-
surrounding residential improvements.
z =,�; "�•: ,_r'Y
Other land
(2)
�r.
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
.
Assessed Mobile I ManufacWred Home
Garage
(5)
Other improvements
(6)
Total improvements (Arne 4 through Gne 6)
(7)
Total value (line 3 pits fine 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verilprp action - signature of Auditor
Date signed (month, day- year)
STANDARD DEDUCTION
[u_ pay 20 _ 45.000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation
S
w 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor
its signed (month, day, year)
STATE FORM 53569(R2'5-09) TREASURER FOR TS-IAI
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1-22:5.1
IMPORTANT NOTICE TO.HOMESTEAD PROPERTY OWNERS
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this •
rl-duction 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.
•
•
•PAR 1: PROP R 'INFORMATION
•
Taxpayer Name Property Address State Parcel Number Leval Description:
Mike J Hulfachor 5073 N 200\V 26-04-14-10p-002.438-018 PT NW 14 I I I 2.133 AC
PATOKA EN 47666
Complete and return to: (y/\(\)/
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
•
PART 2: TAXPAYER INFORMATION -
Oi,ner I First Middle r Grl` Last
N1rk� ' !
//-y''u/ QO/
Mailing Address(number and street.city,state and ZIP code)
Sane as property address
5073 /✓;Doti-, 4R10/ca 1J/`' ' '? 66
•
•
• • •
Spouse First Middle Last
Mailing Address(nunter and street.city.state and ZIP code)
Same as property address
Social Seamy Nurtber(last 5 digits) Drivers License State ID Number(last 5 digits) Soo Other(please specify in Pan 4 below)
_q. — — --- '- ,_ : tART3;,CER'�'1�1G-1T[O\, '..—;—r
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.
Owns I Signature Date
( )
PART 4:ADDITIONAL INFORMATION-
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