Homestead_Bartley %MMME FORM!)•M nen-on TRFATUIIA FOR411A
.APrR(T'Et BY STATE DRAW Or MTTAA.T5-_nv PRERNPFnnY nlr.DEPARTMEN. T OF LRAL rOStctNMFKr FPA\t'E K:44.1.2:41.1
101 N Main n County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N
PRINCETON IN 47670 Individuals and married couples ate limited to one homestead vanda&deduction.As the receipt of this deduction becomes
`.t more beneficial,there is more incentive than ecer for homeitead fraud.homestead fraud causes higher tat bills for all:therefore.
HEA 1344-20!9 requires tatpavers who receive the homestead standard deduction to verify tlut they one eligible to recent 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 he accessed by authoriled county officials.The Depanntent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Bartley, Randall W/Jean M •
Oakland City IN 47660
4803
Randall W/Jean M Bartley
8157E 300 S State Parcel Number Legal Description
Oakland City IN 47660-8512
26-13-28-400-000.027-004 002-00027-00 PT NW SE 28-2-9&2-9 2 AC
C-1
•
PART 2: TAXPAYER INFORMATION
Owner I d /I W
First / , Middle Q Last
and ck_kL O.,y rte_ (E3aYi/Ey
Tg Address(number and strcet.city.state,and ZIP code) Sutnc as propeny address - - ----
9/ 5 7 S 360 S K ICLa1CJ C fy 2.vd/aArcr` 97660
Spotlit First Middle Last
cJ can /72a -/ e. &trtiay
Mailing Address(Number and street,city,stale,and ZIP code) Q'Same as property address
8'/5 /7 g 300 Oct K/at.Ltl C , /y - /t/• 417(, 60
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
•
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT /STANDARD DEDUCTION HCIO
State Form 5473 (R614 -M)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions. IT -d Tl— 5 17,111h.
I (We) / /11 r certify lhf~�he�l s, d '*March, 20
QRfe) occupied as our principal place of residence foll 'ng described real property for which a Hom stead Property Tic Credit' is hereby daimed:
LKJ 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.0ie<p "rdQORy w I r amend r— a�nVad.
•0 GlaaoY'i)rv, . r.uvin
F= .a..ti su c��*r -- r- ra „w" t _.z. -. c •�
.rts�.ca -3is�. �1����� .v�_3_".�'i>�'`�r�`>•�iT- CONTR: CCTRECORDEO�t� ,c�!�rs�- ��,a�s�•3°'Z�,�'{
If buying on contact, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
<t.>:.ssrt r- i• ii4x`'''.
-- a-.••.._ t
sPROP ,ERTY<DESCRIPTION.i,-"w,?.s.L
County
Township
Si ure of claimant
!!�
Taring district , towrt.loumship)
Parcel number
Legal description
VALUE
. '!':kc ?., ,..r�3'.
Is the property in ques'
wN�'
040 g? —OW
I
-
Dropeny ❑ Mobile Home (I.C. 6f. 1-7),
H any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
?` s. i' z"" �'-,... t., 1����.. a. ��ii�• �!'. u' �'? J-='.-'' a�PROP .ERTY;OMINED'BY.CLAIMANT;IN! OTHER °COUNTIES f4��., �. �,. �., �z-. dry'.�;,����?_�?`?�'+�°,s�`,s'
County Township
County Township
1 hereby certify the above statements are We, correct and complete.
Si ure of claimant
!!�
iress (number and street, city, state, ZIP code)
Signature of Auditor
20_Pay 20_
Lesser of 112 Homestead
valuation or 535.000
�i
TRUEeTAX ,
""
ASSESSED VALUE
"ATt100
HOMESTEAD
°'
• NOON-- RESO)ENTIAL ?+
�r�.?
VAI:UE`
-_ ...
%.OFTTV
w.,..�....... .a�.. -.-i
VALUE
. '!':kc ?., ,..r�3'.
$VALUE u'x`
-,
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
f`-1 AhRn l jr.'N. N
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)
tb
'is� -a
�<�„
Residential Improvements or Annuagy
Assessed Mobile I Manufactured Home
Garage
(5)$.
- -� _
�
' �'
Other improvements
(6)-
-��', �` }
s„',,
Trial improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line n
(6)
I hereby certify the above is true, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
Signature of Auditor
20_Pay 20_
Lesser of 112 Homestead
valuation or 535.000