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CLAIM FOR HOMESTEAD PROPERTY TAX YEAR -
CREDIT /STANDARD DEDUCTION C,pl�
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance MAR 1 2 [ U
INSTRUC77ONS: See reverse side for riling insnuctions.
FERTIFICATION STATEMENT-;".
4 '
GIBSON COUNTY
I (We) certify that on the tat day of March, 20_
1 (We) occupied as our principal place of residence the following described real pr (erty for whi mestead Property Tau Credit is hereby claimed:
�p (We) owned ❑ Are buying under contract
11 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.
0_NTRACT;RECORDEOLa
. .. -4r.Y .Y3.6'tK'i •TF >'jt,.. Yw%r'e -k -.. rin
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
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P,ROP,ERTY DESCRIPTION r,' .._.> x . {,;'«b.?i: � "',��„e> •. :, o s: � .:
County
Tcwaship
Testing
'fy, town, township)
Parcel number
Leg description
Is the property in question:
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c — ct,1 /U - j - /
I property ❑ Mobile Homo (I.C. &1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) a, tl immediatety wnounds that structure Is used to produce income, describe the use and portion
of the property utilized to produce income. ate,
1- &- 0j0- /0- /p0 -00/. 738 -001
— _ ._. - _ .. _ _ - ru
PROPERTY OWNED`BY CIIAIMANTIN:OTHER'000NTIES .,,�5�,?�
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
sigeatvre olaimant
/�`/'/
ess r .and sheet, city, srpta, Zl a
I P7
a
.AT 100%�OV- -,W
L11151
ASSES.SOYR USgONLY
y.¢VALUE
ASSESSED VALUE
HOMESTEAD
t
"c '' NON= RESIDENTIAL�i
"�f,
4,++-
n vim` .'+�".t�.�e
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a
.AT 100%�OV- -,W
�VALUE#{"�
3. `, .t_...- ....,..a_
V/LLUE
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Land not exceeding 1 (one) acre immediately
(1)
,,
HIM,
surrounding residential improvements.
r4_�'�.'ei'^v
Other land
(2)F
z- s5r-- Y+5
Total land (line 1 plus line 2)
(3)
IResidenlial
Dwelling
(4)
.r - -} A
impro vements or Annually
Assessed Mobile / Manufactured Home
Garage
(6)
r
; ; �7:L : s
Other improvements
(6)
�4 ii a�`SN.i
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 pits line 7)
(a)
I hereby certify the above is true, correct, and
Signature of Assessor
Data signed
complete.
Verifying action - Signature or Auditor
Date signed
TANDARD:DEDUCTION'ALLOWANCE `^ r" a+;, t.} r.°.€ a' f. uh� ,'A,I,:+�sit'''�"r- ci'u'r"`g
20 _ Pay 20 _
Lesser of 112 Homestead
vatuabon or $36.000
Signature of Auditor Date signed
STATE FORM Sit.•(UMW) - TREASURER FORM TS-IA
APPROVED BY SIAM B sRo OF ACCOUNTS.309 IRFSCRIBIT OY TIE DEPARTME\T OF LOCALCM'IX\MEYr FINANCE IC 6-1.1-=4.1
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Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
i 101 N.Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
•F I I E D 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.
APR 2 9 2011 PART 1: PROPERTY INFORMATION - • ,- .
- - Taxpayer Name Location Address
C.'J. Montgomery', Keith/Carol•
8885E 550 S
— GIBSON COUNTY AUDITOR OAKLAND CITY IN 47660
8727 ,
• Keith Montgomery in[I0i 01101[Ill[[Ll[[0L111 [[hII0m1101101[IILi111II_I i nii_iiiii [I
8885E550S
OAKLAND CITY IN 47660-8580 -
• 'IIIIII"I'IIIIIII.'II'I'IIlIlllll'I'll1151111itllIIlll'IIllltitIl State Parcel Number Legal Description
26-20-10-100-001.738-001/PT NE NW 10 3 9 4.0 AC D-8
•
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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.
_ V ?-- PART _TlL\PAYERLNFORM,4TIQN _____:__—____L_- • -
Ow,,., I First Middle , Last
. 1 - _ WCR51Z-C-i , . • . OF
Mailing Address(number and street,city,state,and ZIP code) 13- me as property address
�' d85 E53oS . o CCL. n1y76 &0
.
Spouse
,, First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) V ® Same as propern
•
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 fmancial penalties.
Owner I Signature Date
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