Homestead_Lutz1
0 / CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Forth 5473 (R61403)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing inslnictions.
I e certify that on the 111 to March, 20
I (We pied a our principal place of reside the followings cribed real property for which a Homestead Property Credit is: bereby_cfaimed.,
I (We) owned ❑ Are buying under contract ,,nnnn
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 contafi4
If buying on contract, Fee Simple owners name
Recorders office where contract is
Record number I Page
-- - - --ate `.o+e'.L+ r• '.
r" `_ :t- .- -' &- ` „- 3P,ROP,ERT;Y,DESCRIP.TION'c: i '*; •ice �^' -�n"`' c.- 4--- .,�-we`v
County
Township
Taring ' t 'ty, t , I ip)
OTC bar O
�
Legal description
Is the property in question:
USE„'ONLY � '
x�`, r
Jrsneal property ❑ Mobile Home (I.C. 6-1.1 -7)
H 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 uffmod to produce income.
G -6/1;?- -
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County
Township
County Tmnship
I hereby certify the above statements are true, correct and complete.
Signatu
Address (number and street, city, state, ZIP code)
Signature of Auditor
Date signed
USE„'ONLY � '
x�`, r
�TRUETAX P -
's VALUE 4"s.7y
ASSESSED VALUE
ATt700 %OFTTVA
HOMESTEAD;
'-VALUE��
`� '� xNON 2ESIDENTIAI n
"�!1'$'VALUE "r ?'LA's
Land not exceeding 1 (one) acre immediately
(1)
*uI D
surrounding residential improvements.
-
r,3 -w`
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
t4>F P”
Residential
improvements or Annually
Assessed Mobile / Manufactured Hone
Garage
(5)
V
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 We, correct, and
Signature of Assessor
Date signed
complete.
,
Verifying action - Signature of Auditor t
Date signed
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20_Pay 20_
Lesser of 112 Homestead
Valuation or 535.000
$
Signature of Auditor
Date signed
STATE 1 ORM 5t5'IR_/RANI TREASURER FORM:SIA
ATM/WED BY STATE BOARD Of.4`0 MINIX 20 Po PlUESCIUBED BY
HOMESTEAD PROPERTY LOWNERS '
Gibson County Auditor
101 N Main
PRINCETON IN 47670 Individual.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 1344-2009 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
tiling:.This information will be kepi confidential and can only be accessed by authorized county officials-The Itepanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Lutz, Justin P
Hwy 41 North
_ Ilazleton IN 47640
13
Justin P Lutz 7//
.- 211,
f11 Du.,33 /"' us. /�'�/y 7r
HAZLETON IN 47640-9217 State Parcel Number / Legal Description
1t1tt11trt1t 11ttt 1tt 111tttlt1tt lt1t1ttt 111ttr1tIlrtlt�ttt�rlr� 26-02-31-300-000.243-018J 010-00243-00 PT SW FR 311-104 AC
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 / 1 First p / Middle Last
(4257/,1 / a-u / Gc 722
tng Address(number and street,city,state,and ZIP code) 9-5The as property address •
71(9 iij. /7, / hl a/ -.-- _ 1771/0 -
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID N umber (last 5 digits) Other(please sluif in Part 4 below)
eras _ — — __ — �_ _.
PART3 TIO —' . .. — — --
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
•
I