Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
Homestead_Clark APPROVED BY STATE BOARD OF ACCOUNTS.2009- PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE 1061.I-22-8.1
a
IMPORTANT.NOTICE TO HOMESTEAD PROPERTY OWNERS
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
•auses higher tax bills for all; therefore, HEA 1344-2099 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 .
I Government Finance will use this information to create tools that will help county officials eliminate .
homestead fraud.
•
'PAR 1: PROPER Y<INFORMATION _
Taxpayer Name Property'Address State Parcel Number Lent Description:
Chad J/Debbie L Clark ,r ss gme O S7° E e2jSr'y 4-°(.°� 26-19-32-101-000.222-024 004-00222-00 MACK CURTIS 18/52
->L76 39
Complete and return to:
GIBSON COUNTY AUDTTOR, 101 N MAIN PRINCETON IN 47670
- z''''.7-7".---.----------- - -
O 1 Fast Middle Last
Chadl sap(,L >et I Clark .
Mating Address(punter and steel city,state and ZIP code) - I game as property address
510 .F F. .E swth o We.r Lvt . l -los -e+ I -1 Y1 i,39
.
Spouse r0. - _ First _ - /�Pri..- la f". -• Last
Mailing Address(ranter and street City.:state and ZIP code) - . Saran as property address -
•
•
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
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
State Fmn 5473 (R6I4-03)
Presaihed by the Department of Lorai Govemment Finance
INSTRUCTIONS: See 2verse side /or fifirrg instnictions.
,
FORM
HC10
��
YEAR _
� (we) // / (iC.(X l! (Jl�,e.AC /J� /./Y � ( /.ei/t /yl certif t�at on '� � "
' • � v 1sYday�of#drep.
I(VJe) occupied as our principal place of residence the following desuibed real property for which a Homestead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under wntract F t� 1 6 Z0�/
Have a benefidal interest in the enfity that is liable for the property taxes on ihe property and that owns the property
If buying on conNact, Fee Simple ownefs name
Remrdefs ofice where wnVact is recorded
Twmship
� �-flOd �3 -d���"'��,�/ (__-_.�
If any poNOn ol the residentlal sW cture w the land not en ing one (1) aue Ihat imr
of the property utiized tn produce income.
�Q,� �aG- i4-Ja -ioi-�. aaa -oa�
disUict
Is N8
surtoundsihat
Record number
a contract.
Page
Mobile Momo (I.C. 61.7-7)
is used 10 produie income, descnbe Ne use and portion