Homestead_Clark • 11at FORM`MO'WC2/ Oct TRE5WUR FORM 75-IA
APPROVED RV MATE MVN OF Ar t*.NTS 5n, PLISCPIBID BY THE DEPMneEIT OF LOCAL roaNstrNr fe:AsCE IC 41.1-2241
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 e'er for homestead fraud Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taxpayer 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
filing.This information will be kept contidauial and can only be accessed by authorized county officials.The Depanment of
Local Gmenvnent Finance sill use this information to cream tools that will help count'officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Clark, Ramon Gene
RI Box 263
Francisco IN 47649
1789
Ramon G Clark
7566 E SR 64 State Parcel Number Lezal Description
FRANCISCO IN 47649
—" —° — — —_26-13-21-100-000469-004' D72:00469-00 PT SWNW 21:2:97:66A --
C—
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
-Ramon &tie- Clark
•tg Address(number and street,city,state,and ZIP code) Same as property address
751P Iii F 3e L`4 Fain cis Ca _I N 1-{110 49
Spouse First - Middle Last
— t, &ran - - _ \I-Lab-4k X�alrk
Mailing.Address(Number and street,city,state,and ZIP code) 0 Same as property addraas
1S G 5Q ED U tRra-n cAs06 . N---\ `47 (49
Each undersigned lies,under t•.:r . t , ry,that the above and foregoing information is true and correct and that he or she is eligible to
receive the hamm�standard .-.P tiy�is property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,h 7 she may be 2:,e f. taxes and substantial financial penalties. .
Owner 1,S':.i" i Date
C�/�
.
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R817 -07)
Prescribed
by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FORM YEAR
HC10
I (We) K. in-n ( ' Q certify that on the 1 st day of March, 20_
I (We) occupied as our principal place of residence the following descnuc. ..al property for which a Homestead Property Tax Credit is hereby claimed:
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 awns the property or is buying under a contract.
7' 1 F - =" "- r �•',CONTRACLRECOROED. ;- � x. - -�' ;;tf�
If buying on contract. Fee Simple ownees name,
County
Toxnship
Taxing
Parcel number Legal descr rip bon . / II is the property in question:
V' W `'W Q ClDaal
property ❑ Mobile Home (IC 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately wrrounds that structure is used to produce income, describe the use and portion
at the property utilized to produce inome.
a, la -13 - a, I - � o 0 - 600 . L► (� _ cX� y
County
County
I hereby certify the above statements am true, correct and complete.
(number and street, city, state. and ZIP code)
Of
Township
qW pay 20 _ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 112 44,000 for 2008
Homestead Valuation pay 2009 41.000 for 2011 pay 2012 $
Of 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor Date signed (month, day, year)
rr
Land not exceeding 1 (one) acre immediately
w,
surrounding residential improvements.
.,_•.,..� ��
- _ .,
Other land
(2)
Tdal land (line 1 plus line 2)
(3)
A
Residential improvements or Annually
Dwelling
(4)
Assessed Mobile I Manufactured Home
Garage
Y
F 's-
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying adion - Signature of Auditor
Date signed (month, day, year)
qW pay 20 _ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 112 44,000 for 2008
Homestead Valuation pay 2009 41.000 for 2011 pay 2012 $
Of 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor Date signed (month, day, year)