Homestead_Sandefur° CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
State Form 5473 (R6 / 403)
Prescribed by the Department of local Govenmea Finance
INSTRUCTIONS: See reverse aliob for 15p i ubucdom
FORM
HC10
JE
Ij
I (We) L/ certify that on the 1st day of March, 20
1 (We) occupied as our principal pla of re &I nee the following describe 1 property for which a Homeste d roper redit is hereby claimed:
/e) owned El Are buying under contract o" NTY AUpITOR
' Have a beneficial interest in the entity that is liable for the property taxes on the property and that WgSQ $?dirty or is buying under a contract.
If buying on contract, Fee Simple owners name !i
Recorder's office where contract is recorded Record number Page
sf�,:,^-- : #�.v. ,,... .r,,yy •t` -° t`ixt-< _
County Tovnship County Township
1 hereby certify the above statements are true, correct and complete. Sign lure claimant r
dress (number and street, dry, state, ZIP code)
rASSESSORIUSE ONLY -ft&
PROPP,ERT.Y_ DESCRIPTION -�,.,,,��,,.�._,.`a?..��
County
Tismship
Ta in is ' rity wnship)
Parcel number —
L de cri io _
e9 � r^.+ Is the pro dy in question:
ClY eat property ❑ Mobile Home ( /.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that imm diately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
County Tovnship County Township
1 hereby certify the above statements are true, correct and complete. Sign lure claimant r
dress (number and street, dry, state, ZIP code)
rASSESSORIUSE ONLY -ft&
- ,!k-ate
ASSESSED VALUE
+HOMESTEAD€
Y
NON iEStDENTIAL
:;?:
r
VALUE.:
Signature of Auditor
VALUE�y $.
a:!,`o� VALUE..?}ai.�'�
fF>F>
,AT.,100%_OF'T7V,;
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
t4ny Lti"' '�±-:,
�, +A::r••
Other land
(2)
r
7{�
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
£.r�>`.ite_�.'..t ?a%';3
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
•� - _
ry
08%,
Other improvements
(6)
fiw°.� -_' s;
: IrQ ar.l
Total improvements (line 4 through line 6)
(T)
Trial value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signawre of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
.�STANDARD:DEDUCTION'ALLOWANCE t
20 _ Pay 20
Lesser of 112 Homestead
Valuation or 535.000
S
Signature of Auditor
Date signed
. - RATE FORM 5356 (RS/RIO) .. - - TIEASLRFA FORM TS-1A
APPROVED By STATE BOARD OF ACCOUNTS MM PRESCRIBED BY Tilt DEPARTMENT OF LOGALGOVERMMEYT FINANCE It 6-1.1-22$.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deducuon becomes
Princeton, IN 47670 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.fmud.
_ PART I: PROPERTY INFORMATION•'�'�' Taxpayer Name Location Address
- Sandefur, Larry J - '
— AP APRo2 6 2011 . - 88785 SR57
_ 11 _ELBERFELD IN 47613
Cr '...C1 •
2887 •
Larry J Sandefur •G•9GI860N CJ )N3Y&8DIiDR III II II IIIIIII I II II II011111111II=
IL II I 111-I II 111111I1_III III
8878 S State Road 57
'ELBERFELD IN 47613-8445
IIIIIItt1111111"1"1III1111IIIIIIIIII1,1,1.1I111I41PIII11II111 State Parcel Number -- Legal Description
26-20-28-100-000.488-001-/PT W 28-3-9 2 AC• D-19 . .
y
This form-MUST be returned to County Auditor's office. -
Please do NOT send this form back with your taxpayment to the county treasurer.
`I PART 2: TAXPAYER INFORMATION
I First Middle Last
Mailing Addresgitber and street,city,state,and ZIP code) -Ii Same as property address
-
Spouse First Middle • Last ,
MallifirKddress(Number arse strccCcity,state;aiidZlP code)'- - _ D Same as propenyaddleess - - ----7------ -
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below) ,
•
I 1 I I 1 I I I I Sr
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