Homestead_Crisp . RATE FORM!neencr YYI MJtMMA FORM SU
srrtm'En By STATE&NRO OFACO J TS.-ux PRYNBEL BY air DEPARn it OF LOCAL rovrnN'S.NT FNA]CE a'•-ti-r-ai
('al1 N County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N Main
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sundanl deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than eser for homestead fraud homestead fraud causes higher tax bills for all:therefore.
ill HEA 13-14-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional idenufvmg informaton necessary to allow county goverment to better monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Depannrent of
Local Government Finance will me this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Crisp, Dale N/
206 N Polk
Fort Branch IN 47648
191
Dale N/ Crisp
206 N Polk State Parcel Number Legal Description
Fort Branch IN 47648-1014
I 11110111111181111111011111111 _
I - 26-18-13-403-000.379-026 011-00379-00 PT W SE 13-3-11-.12 - -
I IIt I tt III tell I t I tt
BEING PT OF PATTERSON 7 PT
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
IBC- e. N e6ts ap
nit Address(number and sneer,city,state,and LIP code) - - ' - -- jSatee as propkty a:ur-..ss - - —
2.Olp N• ?o l'C 6{ . ror± .oratt( -1n/ ,i47 Li?
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 - nature Date
Sp
� :.,.E .
i=
' ��'_�'.
'i`C�tR�,7-�i
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2 / S92)
INSTRUCTIONS: See reverse side lor (ling instructions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT
�vVe) �� �S certify lha�t o�n t�he �si_dj y of Mar�h, 19_
I(We) occupied as our principal place of resi nce the following descnbed real properiy for which a Homestead Property ian Creditii, s h�Eieby�claimed:
❑ i(We) owned ❑ Are buying under contracl - ��!y'° ���
❑ Have a beneficial interest in the enlity that is liable tor the property taues on�the property and that owns the property or is buying unde��niract.
MpYU7� ,
CONTRACT RECORDED , �(,/ /% � II
If buying on coniracl, Fee Simple owners name �/^ ��</--��(7"�
M^'_ _.�.�. - . .1±t+.�(' .
Recorders offrce where contrac[ is recorded Recoitl�mirimber • Page
PROPERTY DESCRIPTION
Counry ^� O� Township � � Ta�dng disirict (�wp fo iP1
yj /O 'i .
Parcel num r Legal tlescription
C�/ - ov�7�—o0
I( any portion of ihe residential slrucNre or ihe land noi exceeding one (t ) acre tha[ immediatety sunounds that structure is used ro protluce income, describe Ihe use and poNOn of
Me properry uNized to produce income. �
� PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
COUnty TownSNp Counry Township '
Si nat f cl "mant
9
��reby certify the above statemen?s are true, cortect and complete. -�
Atltlress (number arid streef, ary, state, ZIP �de)
�20 /I/: �/ ST For� %�•-a� olr Z/1/ �t 7 6�/�
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (��
surtounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5) �
�Other improvements (6)
Total improvements (line a thiough line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correCt, and Si9nature of Assesor Date signetl
complete.
Veritying action - Signamre ot Autlitor Date signed
-� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
e ser of 1/2 Homestead �
V ati n or 52,000
Signature ol Autlitor Date signed C
�—�^ /