Homestead_Oliver (2)7 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION
State Form 5473 (F614-03 L-11 01
1
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
NOV 0 9 2004
u
I (We) wi,(Z40i & 2 uu'-y I � 4 11L certi l-
I (We) occu he kis our principal place fiesidence the following described real property for which a Homestea� �,,Rg VIXIM9 &Qme�
❑ 1 V, d ❑ Are buying under contract
'Have a beneficial interest in the enfity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
uTRACT.-'RECORDED
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
—M, AW
County
Township
County r Township
ltnq ri,town
Sig ature of claimant
(number and street, city, state, ZIP code)
K
T
PZ707be6
9��
Is the property in uestion:
property
IP�-60`
property ❑ Mobile Homo (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding we (1) acre
of the property utilized to produce income.
that immediately mounds that stpdciure is used to produce income, describe the use and portion
surrounding residential improvements.
17 k--j
_
— 44)l 9 -401.
IS-R—J-0— PRdPEkTYbWNEIS7BY
County
Township
County r Township
I hereby certify the above statements are true, correct and complete.
Sig ature of claimant
(number and street, city, state, ZIP code)
K
dress
11111111111if-
FA
I - I STANDARD: DEDUCT10NIAL—LOWANCE-,i'�W;01-q6k�;Z,%
20 _ Pay 20_
Lesser'of 1/2 Homestead
Vatuation or 535.000 $
Signature of Auditor Date signed
�W
MN WA�EiUSE ONLY,
t—'-
SSESSED VALUE
45�1H—
ME—ST—E:A11, -
r -6E— - - 6
rtY
IS " -1
VA L E,qg
j00%,6F ry q
&A
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (fine 1 plus fine 2)
(3)
Dwelling
.g�
KAN M,
Residential improvements or Annually
Assessed Mobile/ Manufactured Home
Garage
(5)
Other improvements
(6)
max Us.
Total improvements (tine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
I
verifying action - Signature of Auditor
Date signed
I - I STANDARD: DEDUCT10NIAL—LOWANCE-,i'�W;01-q6k�;Z,%
20 _ Pay 20_
Lesser'of 1/2 Homestead
Vatuation or 535.000 $
Signature of Auditor Date signed
STATE FORM 53569(R3/5-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-LI 22-6.1
, IMPORTANT NOTICE TO HOMESTEAD 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
• 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.
- .. PARTI PROPERTY INFORMATION .,r '!i " .::: .. {:. , `y
Taxpayer Name Property Address State Parcel Number Leeal Description:
Jason R Oliver 6611 S SR 57 26-20-14-100-001.879-001 PT NW NW 14 3 9 L754 AC
OAKLAND CITY IN 47660
Complete and return to: I11IIIIUUhI 1111UIUDUIU 11111 1111 EV]II]IIIIUIVll
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
PART 2: TAXPAYER INFORMATION .;.:11 ;..Ti •)-1;..Ti •)-1;::='--iaatii .
Omer 1 First Middle Last
Matting Address(number and street,cry,state and ZIP code)
I (same as property address -
---- 661/ s0-n— id 4 k /9% . '5 7 .
.
pouse First - Middle Last
Mailing Address(number and street,city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) r Drivers License/State ID Number(last 5 digits) I awe 1Omer(Pease specify in Fey,4 Delo.). - -
- PART 3: CERTIFICATION • Tea .*` +f'fi:
Earn undersigned certifies.unaer penalty of perjury,that the above and foregoing information is true and cdirect 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 1 Signature - Data
FILE is.
• NOV 132012
GllibUN t,Ourrif AUDITOR