Homestead_Riley (8). �--
CLAWFOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 IRS 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instirtntions.
\Q—ZM — —7
^
FORM
of March, 20 —
I (We) occupied as our principal place of residence the follcnMng des ad real property for which a Homestead Property Tax Credit is hereby claimed:
C1 I (We) owned [] Are buying under pvntmm
Wave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property orin buying under acontract.
If buying m contract, Fee Simple owners name
R�rders office where =treat is recorded Record number Page
County
Tomnship
IT
wriship)
number
(number and street, city, state, ZIP code)
Signature of Auditor
Is the propvr��Iuestion
V*d�gtion
i� an -
surrounding residential improvements.
If any portion of the residential structure or the land not exceeding me (1) am that immediately surrounds tAt structure is used to produce income, describe the use and portion
of the property tifilized to produce income.
County T�nship
County
Tmnship
1 hereby certify the above statements are true, conect and complete.
Signature of claimant
(number and street, city, state, ZIP code)
Lesser of V2 Homestead
Valuation or $35,000
Signature of Auditor
Land not exceeding I (one) acre immediately
i� an -
surrounding residential improvements.
(1)
Other land
(2)
Total land (fine 1 plus line 2)
(3)
Residential Improvements or Annually
Dwelling
(4)
Garage
Assessed Mobile I Manufactured Home
(5)
F,,
improvements
,?lber
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, coned, and
Signature of Assessor
Dam signed
Vedlying action - Signature of Auditor
Date signed
Lesser of V2 Homestead
Valuation or $35,000
Signature of Auditor
Date signed
• SIAIE,0,,,, MIR_l'- 0 TREASURER Po0.V:}IA
APPWNEB BY SLUE MWn OrArroI IS,2av PRr9WBIDBY THE OF PART NT OF LOCAL m VERIOAn.FINANCES'6-1.I-22.1 1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple,are limited to one homestead sandanl deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than met'for homestead fraud.homestead fraud causes higher tat bills for all:therefore.
gib HEA 1344-2I0n requires taxpayers who receive the homestead standard deduction to verity that they are clieible to teethe the
benefit and to pnrvide additional identifying information necessary to allow county government to better monitor homestead
filings.This inibrnatinn will be kept confidential and ran only he 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Riley, Mark Richard
•
tt 1 Pox 175
_- _ - - -- - - _ - - - Oakland City IN 476G0
8495 Li
Mark Richard Riley
9216E 550 S State Parcel Number Legal Description
Oakland City IN 47660-8574
I I III I I I I I I III I I I I I I I I I I 26-20-03-400-001.466-001 001-01466-00 PT SW SE 3-3-9 17.875 AC
t o nit ru a ut1etir t tot it nt t nt ie
X
PART 2:TAXPAYER INFORMATION
Owner I First Middle n Last
/741444k,�alg Address(number and street,city,safe,and ZIP code) - --_ Same as props address
9e,& £ 55o 5 o4kLWL C- L7‘10
Spouse First Middle - Last
Mailing Address(Number and street,city,sate,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
site
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury.that the above and foregoing inflnmation 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 1 S' nature Date
(
)
PART 4:ADDITIONAL INFORMATION
III