Homestead_Miller (3)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Forth 5473 (R6I4-03)
Prescribed by the Department of Local Government Finance �
INSTRUCTIONS: See reverse side for filing instructions. IT T
I (We) • ' " • p st_ ' certify that on the 1 s-t da'�%of M2rrdW_
111III (We) occupied s our principal place of residence the following described real property for which a Homestead Proper y Tax Credit is hereby claimed:
Ly`-�t (We) owned ❑ Are buying under contract
��,�,,
T Have a beneficial interest in the entity that is liable for the roe taxes on the roe GI R,, '~
h property rh' property rty and that owns the property or Is'buytng under a contra
«-
• � ._. .iM1^3fA?'St�' %i�x�• µms: -e J - _.[�j...� .�. . �$�- �,�� -,�_
If buying on contract, Fee Simple owner's name
Recorders office where contact is recorded Record number Page
- '�..w_: �''' .__�•.�,.tt'`+v`'�`. EIS' FEZ'• 1i�+ �_, PROPERTYOESCRIP .TION--V%at�0��� ^�ti�
County
Tomship
Tw district city, town, township)
Parcel number
Legal description
Is the property in question:
'• SS -;C:`
ASSESSOR;USE ONLYsy.�+v- �,�s,';+s;:
❑Real property ❑ Mobile Home(I.C.6- f.f -7)
If 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.
aG
'� NON tESIDENTU\L
-w +VALUE y _
.ra:
TPROP.ERTY OWNED',BY.CL'AIMA NT- IN iOTHER"COUNTIES
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and sheet, city, state, ZIP code)
,3 do -r O � T ✓ o
ASSESSOR;USE ONLYsy.�+v- �,�s,';+s;:
TRUE TAX -�-
'ygt;_UE� "fl" -
..J. ..:
ASSESSED VALUE
AT 100 %'OFTTV
s... >....,,.v...3`..
--HOMESTEAD
`r"' *`VALUE
5f..,..
'� NON tESIDENTU\L
-w +VALUE y _
.ra:
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
�»
-, 0 _ --
Other land
(2)
Y
�tw
Total land (line I plus line 2)
(3)
Residential improvements or AnnuaOy
Assessed Mobile I Manufactured Home
Dwelling
Garage
(4)
(5)
yf sy
�... :g � soh,
> $ m
� i1 + `y
Other improvements
(6)
5 h
? ¢
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(6)
hereby certify the above is We, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Valuation or 535.000
Signature of Auditor Date signed
i }FATE FOAM!!W IR'/se. TREASURER FORM 75-IA
■IPMA'EO BY MATE BOARDOE non-PUNTS Zino PAESAIBEDavTE DEPARR@Yr OF LOCAL rovatNMr rFINANCE eH.l-u-AI
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.Ilomestead fraud causes higher tax bills for all;therefore.
• - HEA 1344-2009 requires mxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
flings.This information will he kepi confidential and can only be accessed by authorized roomy officials.The Department 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
_ Miller, Kent S/Arielle L
. \ R3
Oakland City IN 47660
----...)
325,1
K nt S Miller _
581 S 1025E State Parcel Number Legal Description
dq\KLAND CITY IN 4.2660 7/ 13
I I I I III I I I I I ✓ I I I III I I I I I I
26-20-11-200-001.855-001 001-01855-00 PT NE 11 3 9 1.00 AC
t u sett set n nt te set to n t ts nn nt )</- D-8
-- ___- - - - . . _ _ ___. __ — - _ - - _. _ _ ___.
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 First . Middle Last
gel Shelic4 /-1Ar
•ig Address(number and street,city,state,and ZIP code) 2'Same as property address
Spouse First Middle Last
/1r i.t. lie, Ltelth Ill 4;ier---
Mailing Address(Number and street,city,state,and ZIP code) 2Same as property address
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 elieible 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
/
PART 4:ADDITIONAL INFORMATION
•