Homestead_Kelley SLATE FORM!L W ttr IYNI TREASURER fORM ESL
.APPRO.:EDNA STALL M1SRDOFMTW(% ep• PRf4A1BED BY DIE DEPARMRNT OF AXIAL GOVER LM?A'i FINANCE MLI.I-u4I
Gibson County Author
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 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 ner 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 arc eligible to reeebe the
benefit and to provide additional identifying informuton necessary to allow county government to better monitor homestead
filin•)t.This information will be iepi confidential and can only he accessed by authorized county officials.The Dcpannunl of
Local Government Finance will use this information to create tools that will h:Ip county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Kelley, Gerald L/Helen M
905 S Main
Fort Branch IN 47648
7056
Gerald L/Helen M Kelley
905 S Main State Parcel Number Legal Description
Fort Branch IN 47648-1731
26-18-24-204-000.658-026 011-00658-00 LAGRANGE ADD
t o II nr It II nr I n II uu I nn III t Ia II II II nu I lr II
299PT/306PT/307PT
CONTRACT TO KELLEY
PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
herald I_ kell e
ng Address(number and street.city,state.and ZIP code) . _ — - - - - - - Same as property dress----
Q05 S. /Thin ¶-f. rorl 6arcre, , TN Ll r1 f e L/
_
Spouse First Middle Last
i-iden /1/1 . 1 e,11 e
• Mailing Address(Number and street,city,state.and ZIP code) [Same as property acdress
g05 1/4S • ITh, . S-1- . Iirt trz.' • • , (710'418r
...
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
•
•
�f R��
ea °E CLAIM FOR HOMESTEAD PROPERTY TAX � � FoRM
;��;: CREDIT/STANDARD DEDUCTION HCio
��� State Form 5473 (R2 / 5-92)
�J
�su ' ' - ' - - � .� - .
INSTRUCTIONS: See �everse side toi /iling instructions. � _
- � ' � ' ER IFI ON STATEMENT . - � ' - � � �( � �
I(We) . � - certify.ihai on the 14tqay@f�1at�u19
'e upied as our principal place of r sidence ihe following de cribed real p rty tor which a Homestead Prop y Tax Credit is hereby Gaimed:
" I(We) owned ❑� Are buying under con[raci �/1 //
I❑ Have a beneficial interest in the entity that is liable for the.Property taxes on the property and that owns the p e�ty;or.isp�iPg,ud�Ar�a�f�Ft. 0
� � � -� � � CONTRACT RECORDED�� - � � - �
If brying on wntract, Fee Simple owners name � �
Recorder's oHice w�ere contract is recortletl Record number Page
� � PROPERTY DESCRIPTIO � -
Counry .�. • Township Tazirg tlist' ciry fo n, rownsM 1
� . , � ,
�c I n m egal tlescription
�
If any ponion of the resi ential stmcture or the land not ezceeding one (7 � acre Ihat immediatety surrounds ihat sirucNre is used to produce income,
o( ihe propeny utilized to produce inwme.
� . . . � . . .. � . � . - .
Counry
(number
PROPERTY OWNED BY CLAIMANT IN
Township Counry
�
are true, correct and complete. Signamre �
�e' �L � r,�.+�..P� ,
ASSESSOR USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvemenis.
Oiherland
Totai land (line 7 p/us line Z�
Dwelling
Residential improvements
Garage
Oiher improvements
Total improvemenis (line 4 through lina �
Total value (line 3 p�s line �
I hereby cenify the above is true, correct, and
complete.
Ventying action - Signature of Audi;or
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000
SignaWre ot AutliWr
(�)
(2)
(3)
(4)
(5)
(6)
I�)
1e)
TRUE TAX
VALUE
ofASSessor
S
ASSESSED I HOMESTEAD
VAIUE VALUE
the use antl portion
NON-RESIDENTIAL
VALUE
signed
signetl
� 0 i