Homestead_Parisht'
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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Forth 5473 (R13I 12-09)
y- Prescribed by the Departrnent of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
oe13
I (We) certify that 1 (we) my rindpal
place Idence or am (are) buying the following described real property for which a Homestead Property Tax Standard DVudio by claimed
er ntract on the date this application is filed, (date of filing). I (We):
Own ❑ Am (are) buying under recorded contract GIBSON COUNTY AUDITOR
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terns of a qualified personal residence trust
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
Ne of mant (legal name)
n rnber of daimant (
Social Seemly number of claimants spouse (last 5ve digits)
Drivels Scenes I Identification I Other numbs: issuing State
of claimant's spouse (last rive digits)
9.10111
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number
Page
Township Taxing dalrict (city, town, Twnship
County
. Parcel number
Legal description is the property in question:
❑ Real property ❑ Annually assessed rt,.Me tome (IC 61.1 -7)
If any of Me residential re tructu o de lard not exceeding one (1) acre that immediately, surrounds that structure is used to produce income, descri and be the use a portion
d 8 property
• i�c�-
County Township County Township
I hereby certify the above statements are true, correct and complete.
Signature f claimant_ c
Address number and saeeL c+0: slate, acct ZlPcede)
Land not exceeding 1 (one) acre immediately
surrounding residential Improvements.
Other land
2
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annualty
Assessed Mobile l Manufactured Home
Garage
(5)
Other improvements
(8)
r rx Y'__'3y3Fl:
Total improvements (line 4 through line 6)
(f)
Total value (line 3 plus line 1)
(8)
I hereby certify the above Is true, correct,
Sig Signature of Assessor
Date signed (month, day, ysar)
and complete.
Vaityi g action - Signature of Auditor Date signed (moruh, day, year)
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any orherprovislon, the sum of the deductions pmvided in IC 6.1.1 -12 to a rnoble home that is $
not assessed as real pmpeny or to a manufactured horse that a not assessed as real property may not exceed
once -hag (12) of the assessed value of the motile home or manufactured home.
Signature er tw
Da[e signed (month, day, year)
STATE FORM 53569(8318-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 1061.1-22-8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
•
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
uses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
dard 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.
PART(: PROPS• l INFO RMATION .
Taxpayer Name Property Address State Parcel Number Leal Description:
Jimmie V Parish 271 W STEELMAN RD 26-05-48-169 .673-018 PT LOC 169 1-10 1.15 (2.10 AC RD)
PATOKA IN 47666 11I1�7 p rtA
Complete and return to: I®11QQ1000QQQ�QimmW111;I 111mpp
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCE:a, 47670 A 11
PART 2:TAXPAYER INFORMATION . .
Owner I C First }� /� Middle Last
J 1 1h M\ 1� v XL) Cy -� \
Stang Address(nwrber and street.city,state and ZIP cede)
rSame as property address
22 1 t,cJ S-i4 a(vka.. `d il kro tc-A- :rrt- ) k-61(a&(G
1 W First Middle ' Last 175R/3—A
Maim
Address(num ber a street.city,state and ZIP code) /I Same as property address
it 1/1/ ageIhit) T Pr9fa �,4
yy V266‘
_ '
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
- °.
(2 /t, PART 4:ADDI'i'IONAE INFOR\IATION
1 T J L' TN
S 1t.1I__J IL/ JL1/
. • Nov 2 22012
r' 4 it --r9----
GIBSON COUNTY UDITOR \\'