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Homestead_Tislowt` d. 4 CLAIM FOR HOMESTEAD PROPERTY. TAX FORM F YEAR ` CREDIT /STANDARD DEDUCTION HC10 State Form 5473 (R2/1 -90) INSTRUCTIONS: See reverse side for,filing instructions. g� g� / CERTIFICATION STATEMENT -VT Y 4 - P H � 11 (We) o certify that op,e t'K I� s day of March , 19� I (We) occupied as ou principal place of residence th ollowing described real property for which a Homestead Property Tax Credit is hereby claimed: I (We) owned 1 161 ,rrmly j2g under contract Have a beneficial interest in the entity that is liable for the property taxes ��1 tYrl?��bp__eoorty and that owns the El property or is buying it under a contract. CONTRACT RECORDED If buying on contract. Fee Simple Owner's Name Recorder's office where contract is recorded Record Number Page PROPERTY DESCRIPTION County Towns Taxi ist t{ t , to n, otAnshi �: h S o K) LL) 1L Parcel Number Leg �1 Description 0(00 000 `4 l o o —ro �j -qo If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc- ture is used to produce income describe the use and portion of the property utilized to produce income. ez- oa -14- /o% Doo.x'90 -a g PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES County Township County Township I hereby certify the above statements are true. correct and Si(¢'�� ture ((�� cmmnlete- \_n PAIW, ;d,� .r Address (Street, numbe�((, city. state and code) r 2_ Q_ IoL , U-1, )- e1–te Q o - ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL VALUE Land not exceeding 1 (one) acre immediately surrounding residential improvements Other land Total land - line (1) plus line (2) Residential improvements Dwelling Garage Other improvements Total improvements - line (4) through line (6) Total value - line (3) plus line (7) (1) 1991 Pay 1992 19— Pay 19 Lesser of 1/2 Homestead (2) Lesser of 112 Homestead Lesser of 1/2 Homestead Valuation or $2,500 (3) Valuation or $1,500 Valuation or $1,500 (4) - - - - -- - (5) ate Signed S (6) (7) (8) I hereby certify the above is true, correct, and complete Signature of Assesor Date Signed Verifying Action - Signature of Auditor Date Signed STANDARD DEDUCTION ALLOWANCE 1989 Pay 1990 1990 Pay 1991 1991 Pay 1992 19— Pay 19 Lesser of 1/2 Homestead Lesser of 112 Homestead Lesser of 112 Homestead Lesser of 1/2 Homestead Valuation or $2,500 Valuation or $2,000 Valuation or $1,500 Valuation or $1,500 Signature for ate Signed S STATE FORM 53569(R315-10) TREASURER FORM TS-IA APPROVED BY STATE BOARD OF ACCOUNTS._2009 . PRESCRIBED BY TIE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1 IMPORTANT NOTICE TOTIOMESTEAD: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 buses 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 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. PARTI;:! PROPERTY' • ;FO'MA ION Taxpayer Name Property Address Slate Parcel Number Legal Description: Jerry L Tislow 1870 E DEAD LEVEL RD 26-02-48-101-000.890-018 PT LOC 101 1-10 9.90 AC ' AZLETON IN 47640 Complete and return to: I11111I0M®©QMn0Q0ll�11MIEBQQDDIDQB®m® GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 476701 . ` - PART-2 TAXPAYER ILNFORMATION • . Owner I First Middle Last —mss _� d C eo iiSLOc-3 Matting Address(number and eet.dry.state and ZIP code) i>6 Same as property address Post - - Middle . ..Last Malmg Address(number and street city.state and ZIP code) I I Same as property address Social Scanty Number(last 5 digits) Driver's license/State ID Number(last 5 digits) state Other(please specify in Part 4 below) • . PART 4:ADDlTIONAL.INFORMATION sIn)G-1 - MD Sous L - = rJL . ..- - --- - . , NOV 5 20`1`1 " GIBSON COUNTY AUDITna