Homestead_Jones (7)CLAIM FOR HOMESTEAD PROPERTY TAX FORM
—YEAR
"
CREDIT/STANDARD DEDUCTION HC10 3
State Forrn 5473 (R5 / 10-01)
w Prescribed by the Department of Local Government Finance tI,
INSTRUCTIONS: See reverse side for filing instructions. { 7�,l�� j-� I ]I l
I (We) 1 LC/ certify that on the 1st day of March, 20_
I (We) residence the following described re property for which a Homestead Pm�perty Tax Credit is hereby claimed,
F1 I (We) owned ❑ Are buying under contract /L�J
GIBSON COUIdiv anrnr�A
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.
If buying on contract, Fee Simple ownees name
where contract
Record number I Page
PROP.ERTY,OWNED;BY- Cal MA WT. IN;OTHERtOUNTIES';n..,,,.
�PRO0ERTVJdESCRIP.TI6N
County
Township
Taring district (city, torn, township)
P ben n //��
'� Of✓ 8 �� QV
Le scri tian
j
O
Is the property in question:
❑ Real property ❑ Mobile Homo (I.C. e- I. 1-7).
If any portion of the residential structure or the land not exceeding one (1) ace that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
acL). 861-
PROP.ERTY,OWNED;BY- Cal MA WT. IN;OTHERtOUNTIES';n..,,,.
County Township
County Township
I hereby certify the above statements are true, coned and complete.
Signat a of 1 1 nt
011 QA rzr-N ss (num rand street, ate, ZIP �' ^ Q rt
°-° rx`�- �>•"frr'4'�T'r+ - 'TRUEeTAX
-�1 ASSESSOR�USE ONLY '�-
'
ASSESSEDVALUE
OIAESTE/J
NON- RESIDENTULL a
`+:>
,..
yAI:UEu
....a��
"AT 100 %OF7TV`""TVAL'UEC
-..�. 9$:0.v —M
F';�.9L-�.4. -., c0
Land not exceeding 1 (one) acre immediately
(1)
tigf�a
surrounding residential improvements.
.3zwR'•` .,,'��2
Otherland
Total land (line I plus line 2)
(3)
Q0
Dwelling
(4)
Residential improvements
Garage
-
(6)�,r1'_-
- -'
Other improvements
(6)
M
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature ofrwditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Valuation or $6,000
Signature of Auditor
STATE FORM Let.MN -nl 17SANEER FORM 79-1A
.1rrtrwrn nY ST11E WARD Of"(TVawlcry/n PILESX/BED BY TtIr DEPARTMENTOF LOCAL CANLR.NMrAT FINANCE c'VI.1"-Fl
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.
HEA 1344-?009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to creche the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings'Ibis information will he kept conlidemial and can only be accessed by authnrited county officials.The Depannlent of
Local Goverment Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Jones, Shane D/Rachel D
n 1 47640
1184
Shane D Jones
1794 E Giro RD State Parcel Number Legal Description
Hazleton IN 47640-9375
IIIIt IItttlriItlt Iltllll tt1F1rtlt11t1ttl 1t1F1r 1F1ttr1r F1FF1F11 26-02-58-017-000.866-018 010-00866-00 PT MD 171-101 AC
PART 2:TAXPAYER INFORMATION
Owner I ) First Middle Last
la e__ Dar Jon s
•ig Address(number and li&i..city,state,and2lP collet - — --' -— Same as property a:idrv,: -— — — — --
9g5 is SIR 5 6 HpzLemon i1 y76v0
Spouse First nn Middle Last
RaCti -e L Y Too e,
Mailing Address(Number and street,city,slate.and'LIP code) ..Ole as properly address
$cis L 5R 5 to H4 L&#ou ii Ll76Yo
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 Signe Date
• v