Homestead_Pleissiw ^0
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
S l State Form 5473 (R2 15-92)
INSTRUCTIONS: See reverse side for filina instructions.
FORM YEAR
W 0 (�
I(We) _ 7cJ cMity_tbat.omthe,t day_o Marcfi, 19
I ( st
We occupied as o incipal place of residence the following described real property for which a Homestea f #r6p' erty Taz:Credit- elieiebiy claimed:
❑ 1 (We) owned ❑ Are buying under contract
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.
CONTRACT RECORDED..._ »_
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
-..PROPERTYDESCR
'Township
"ON', .° ,�.'a'.�
County
County
Township
Taxi clisuicycity own, to
Parcel number
Legal description
V —
Land not exceeding 1 (one) acre immediately
It 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 utilized to produce income.
surrounding residential improvements.
z- &0--
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
P
ress (number and street, dry. state, ZIP code)
R. o 14,421 - ro 'f7 Itiii -10
-
.ASSESSOR USE ONLY
TRUE TAX:.'
_ ASSESSED -
HOMESTEAD -
VALUE '-
-, NON•RESIDENTUIL. -
VALUE
-,.
_ _. - _
- VALUE-_'
- .VALUE
Signature of Auditor
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
_
Other land
(2)
-yy;_. ,,•, .
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
'
Garage
(8)
-
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pbs line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
-- _ - STANDARD DEDUCTION ALLOWANCE - -
19_ Pay 19_
Lesser of 1/2 Homestead
S
Valuation or $2.000
Signature of Auditor
Date signed
St sIE FORM!3'M IR'!!+NI tM'.WiRIR FORM TS-IA
APPROVED BY STATE MARL Of AMVMIVTs iw PRPYRlnmBY tar DEPARTMENT OF LOCAL DOVERNMEla FI:%Mt M 11-I.1_'-t.l
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples arc limited to one homestead saadanl deduction.As the receipt of this dedunion becomes
_ more beneficial,there is more incentive than eser for homestead fraud.Homestead fraud causes higher lac bills for all:therefore.
® HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they am eligible to remise the
benefit and to provide additional identifying information necessary to allow county geneminent to better monitor homestead
filing_ Ibis information will he kept confidential and nn only be accessed by authorized county officials.The Depanntent of
Local Government Finance will use this information to create nVla that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Pleiss, Larry J/Dana L
6216N50E
Hazleton IN 47640
986
Larry J/Dana L Pleiss
6126 N 50 E State Parcel Number Legal Description
Hazleton IN 47640
26-05-58-021-000.697-018 010-00697-00 PT MD 21 1-10 22.33 AC
X
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
L ARR y 3 PL E/SS
�ng Address(number and street,city,state,and ZIP code) - -Same m property address - — - - —
1 2/ (a A/ S6 E 1-4A2. Lc rav, /At/ 9,7(o
Spouse First Middle Last
Df)Nn L PL E7ss
Mailing Address(Number and street,city,state,and ZIP code) [ Same as property address
622 (o AT 5R6 E HAZ LE-Tor/ , Y/✓ In4, iio
_____
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 immature () Dale
PART 4:ADDITIONAL INFORMATION
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