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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614 -03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing instniclions
I (We) 3 J lu'fulq/ , - /via ULZU 1/(C
I (We ccupied as our princ+1 place of residence the following scribed real
(We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on
FORM YEAR
HC10
_a_ IL !
certify that on the 1 st day of March, 20
which a Homestead PrEpsa 115rewl4hereby claimed:
property and that
buying -under a contract.
A=�NTRACrRECORDED��
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
X 11% i =V 5FPt0M� _ -� kOOEkrY.-6ESdifO-TiiN'.?a!� 7- w.-,
V-irh:�
County
Toomship
T is 'ly, to", 4jwaghip)
, 1�5
Parcel number
00 -
Legal description
I
e property in questiom
T
VO
=1-�VALUE'1�1
Wit,
W.Y
Land not exceeding I (one) acre immediately
j �Xeal property
❑ Mobile Home (I.C. 6-1.1-7)
H any portion of the residential structure or the land not exceeding one (i) acre that immediately surrounds that snuaure to produce income. describe the use and portion
of the property utilized to produce income.
?0.0,3 _ 000 _00
surrounding residential improvements.
County
Toomship
I hereby certify the above statements are true, correct and complete.
Address (number and street, city, state, ZIP code)
of claimant
i§ESS0kUSEON`Y--�'z ��§v
- EA
;�gTRUE;TAX'P--1Jk;
-ASSESSEDY—AL-bi
HOMESTEAD
N E D E:N
, 1�5
�QR
Signature 5-9/ditor F
x- VALUE M-
VO
=1-�VALUE'1�1
Wit,
W.Y
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other land
(2)
VON o
N
ME CMIR 0-
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
5.
M OR-L
W
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
()`''
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (fine 3 pits line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
TANDARD.DEDUCTIOWALLOWANCE
2 ,y 20
Lesser of W2 Homestead
Valuation or 535.000
0 4f
S
Signature 5-9/ditor F
Date signed
STATE FORM 53569(R31e-10) TREASURER FORM TS-IA
APPRO tD BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.I-22-8.I
IMPORTANT NOTICE TO HOMESTEAD.PROPERTY OWNERS _ r
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
L
!duction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
qp 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 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.
w ;1"OP-ART ITPROPERTY-INFORMATION • -r j -
Tamaver Name Property Address State Parcel Number Lesal Description:
5175 S875E
Bryan Montgomery 26-20-03-300-000.848-001 PT NW SW 3-3-9 1 S23 AC
OAKLAND CITY IN 47660 D-8
Complete and return to: ilium 1[11111I111011111111110011111111111111.11EIME11111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2cTAXPAYERINFORMATION 5674 n' *y�:.r.� �:aeeGi "�
Owner 1 First 11 Middle Last
yr �a� �d�.ior� Pion I6yortu-7
Mailing Add ss(number and street.city,state and ZIP code) Lei Same as property address
Spouse First Middle Last
5e55 1e, L, ee Men-1190MCry
Mailing Address(Camber and stree,city state and ZIP code) f V' Same as progeny address
.,. il' PARTE CERTIFICATION:' a ?Mir :t.ittli
- Each undersigned certi--s, under penalty of perjury,that the above and forgoing information is true and correct and that,a or sha:_eligible to _ va 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 1 Signature Date
v 4 ADDITION jNFORMATION
NOV 8 2012
GIBSON COUNTY AUDITOR
•