Homestead_Hazel 'IAr.FOUL IM10.(MMI IRFASIJLA FORM 1-S1A
MPPRIT'EO BY'flE.MSRnor NYML IS. Vr Mr FIRM BY TIM OEPMTMEVICF RAL rovaMtxT FP::ICE
Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to or homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore. \II'
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verily that they arc eligible to recene the
benefit and to prw'id<additional identifying information necessary to allow county government to better monitor homestead
filingThis information will he kept confidential and can only he accessed by authoriid mainly 011iei:ds.The Depanmmnt of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead timid.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Hazel, Marabeth
911 CHICKASAW DR
FORT BRANCH IN 47648
7628
911 Chickasaw Dr State Parcel Number Legal Description
FORT BRANCH IN 47648-9539
26-19-18-101-001.171-026 ITTLE YORK VILLAGE PHASE II LOT 15
lI tIs II fit I n II teIl ItI nl I tI m II I II io I I u IIt I
Spouse First First Middle Last
Mailing Address(Number and street, 'iy,state.and ZIP code) Same• ropeny address
. •
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is lase 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.
� ,
CLAIM FOR HOMESTEAD PROPERTY TAX 'U'��
' CREDIT/STANDARD DEDUCTION �
\ .� Sfate Fortn 5473 (R5 / 70-01) V'
�� Prescri6ed by Ne Department of Local Govemment Finance
INSTRUCTIONS: See reverse side /or filing instructions.
I(We) l
I(We) occupi as our principal place oi re nce the following described real pmperty (or which a F
❑ 1(We) o ed ❑!ve buying under contrecl
. Have a benefidal interest in the entlry that is liable for the property taxes on the property and ihat
It buying on conVaa, Fee simpie owners name
Recordefs ofice where wntract is recordeE
County
Tamship
__ _..�� ^O __ ' ' -
_�
II any poAion o1 the resitlantiel sW qure w the lan ot e� tling one (1) acre
ol tha property utiized b produce inmme.
O j�-� II-1I-O�
County
FORM YEAR
HC10
� ���
`v 19 ����
i�t on the ts� day of Mar 20_
�operty T�c�Gedit is r daimed:
`;�Y 11A DITOR ,
�erty br�is buying under a wnVad.
'ri ..�.._ ��_�._'Y���l'��A �R�i3:�"�
Remrd number Page
Tmting aiscrict (dry, rown, townsnip)
/ Is Ne property in question:
� ❑ Real Droporty ❑ Mobila Homo (LC. 61./-�
iately wrtaunds Nat swGUre �s used to produce income, describe Me use and portbn
County
I hereby certify the above statements are W e, cortect and complete. °"' °" S/
� / '
�� I( I mber�d st�e(, dty, �fe. ZIP.i2_���i r Cltii � FJ ` .
l � �LlL�1%
�"�.��,�°"j.�a�y��;,;"�,'u�7�y�?�,�r„�; �� STlW DARD:DEDUCTION'ALL'OY4IANCE;fi�,"�,'�,�,,�' , ¢��'.�"���'*,�, a-'"�+����,'_�.�����.-:.._
20_Pay20_
Lesser o( 1!2 Homestead
Valuation or $6,000 $
Sgnatura of Auditw � , �/ Date sipaed '�
�_, � .
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