Homestead_ObertCLAIM FOR HOMESTEAD PROPERTY TAX
-` CREDIT /STANDARD DEDUCTION
' State Form 5473 (R215-92)
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INSTRUCTIONS: See reverse side for filing instructions.
FORM
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IAAY 1n n
YEAR
CERTIFICATION STATEM NT
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I (We) 4- ! / certify that do the�st day Mafdh, 19_
, .
I (We) occupied as our principal place of residence the followi g escribed real property for which a Horgest6dd-Pro`peq Tax Credit.is- ereby claimed:
❑ I (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
PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
Parcel number
Legal description �
If an rtion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structur is used to produce income, describe the use and portion of
the property utilized to produce income.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
Count -
Township
ereby certify the above statements are true, correct and complete..
Signature of oaq ant
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Add re (n mb r and street, city, state, ZIP code)
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ASSESSOR USE ONLY -
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or 52,000
$
Signature of Auditor
Li
Date signed
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RIME Filled sRU••I TREASURER FORM YIA
Ai,rF,wt°uv'T at SwRnm.KfR.Ata.qn PREAWnm BY TIM DEPAATAtC?OF LOCAL CAS2LYMfAT IS:Aat'E MSLI-rat
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 e'er for homestead fraud.I lomestead fraud causes higher tax bills for all:therefore.
HEA 13-14-2000 requires taxpayers who twelve the homestead standard deduction to verify that they are eligible to recent the
benefit and to paw'ide additional identifying information necessary to allow county government to better monitor homestead
filing..'Ellis information will he kept mnfdented and can only he acres.ed by authorized county officials.The Dapanntmt 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
__ _ - Obert. Steven R/Kelly A
R2 Box 114
Fort Branch IN 47618 R
871
Steven R/Kelly A Obert
R2 Box 114 State Parcel Number Legal Description
Fort Branch IN 47648-8564
26-20-19-100-001.818-001 001-01818-00 PT SW NW 19 3 9 275 AC
to satIt II sat I n I I iiI tI I leI tI o I I toI tiI sat I I n I e I et I
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
eaw� i 0
_
•ng Address(number and street,city,state,and ZIP code) _ I- -�,,, 7 -- -- �7 - u Same as property Badres;—' "' _. _ __ _
53/`6 sI Ibp FJ. 13re 1.C1i , .tit g76VD
Spouse First Middle Last
ke l l y 19. Obar
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
1/4-5-3 f S� S R I b$ El- B ro-rr \ , YIJ if 76 o f
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 Signature Date
PART 4:ADDITIONAL INFORMATION
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