Homestead_Bloodworth STATE Lnxit yM,sc:%0•1 tflsSUm FORM 73-IA
ANTI/V D BY MATE ontROOr+MI,,\TS.2l rw,asrDar THE DEPARfSn:YT(rt LOCAL oOVrtNMEAT FINASCE n'6-11-2Z-0.1
Gibson County Auditor
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 ever for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2000 requires taxpayers who receive the homestead standard deduction to verily that they are eligible to teethe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing•..This informamnn will he keg.confidential and on only be accessed by authorized county officials.The Ottumwa'of
Local Government Finance is ill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Bloodworth, Byron K/Marleen K
R2 Box 90 D `/
Haubstadt IN 47639
10937 ����
Byron K/Marteen K Bloodworth -
11699 S S 475 E State Parcel Number Legal Description
Haubstadt IN 47639
26-23-12-300-000.119-024 004-00119-00 PT SW 12 4 10 8.00 AC
D-10
x
• PART 2:TAXPAYER INFORMATION
Spouse First Middle Last
ra0 ) B\ 00d wo( fl1
Mailing Address(Number and street.city,sate.and ZIP code) Same as property address
l/ G4-9 _3'i751c
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.
•
1733
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2/1-90) • �
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
YEAR /
r
CERTIFICATION STATEMENT B � � —D���7 �D
� � +1 �1
I(We1_ ��l�a"v='+; ��, :.y� �%e I�D;n p:; rtify�that on the 1 st day of March , 19 �
��We) oc��N�ea �� our principal place of residence t,�he, /following described real property for which a Homestead
roperty Tax Credit is hereby claimed L�!f I(We) owned ❑� Are buying under contract
� Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
property or is buying it under a contract. .
CONTRACT
on contract. Fee Simple Owner's Name
Recorder's office where contract is
Counry
PROPERTY DESCRIPTION
Taxing District.(City, town, township)
Parcel Number Lega'i.0escriptio - .
c�cw -�oilq -�U c� `�t S.�,v- ��-L-I—IV �� A�
If any portion of the residential structure or the land not exceeding one (t ) acre that immediately surrounds that struo-
ture is used to produce income describe the use'and portion of Ihe property utilized to produce income.
PROPERTY OWNED BY'
OTHER COUNTIES
� � ASSESSORUSE ONLV �� ' � TRUE TAX VAWE ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
' ' VALUE
Land not exceeding 1(one) acre irrimediately ' .
surrounding resideniial improvements (�)
Oiherland (2)
Total land - line (t ) plus line (2) (3)
Residential improvements Dwellinq . (4)
Garage (5)
Other improvements (6)
Total improvements - line (4) through line (6) (7)
Total value - line (3) plus line (7) (8)
I hereby certify the above is true, Signature of Assesor Date Signed
correct, and complete
Verifying Aciion - Signature of Auditor Date Signed
7989 Pay 1990
sser of t/2 Homestead
Valuation or $2,500
Signature of
'-
STANDARD DEDUCTION ALLOWANCE
1990 Pay 1991 1991 Pay 1992 19 — Pay 19 —
Lesser of 7/2 Homestead Lesser of 7/2 Homestead Lesser of 1/2 Homestead
Valuation or $2,000 Valuation or 51,500 Valuation or $1,500
Date Si ne�
� /� —