Homestead_Lutz STATE FORM 53560(R1r SIB) TREASURER FORMnIA
` ° APPROVED BY STATE BOARD OF ACCOUNTS.2CEN PRESCRIBED BY THE DFPARTMEVE OF LOCALGOVEANMENT FINAVCE IC 4-1.1334.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever 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 are eligible to receive the
ill F I L E I) benefit and to provide additional identifying information necrccnry 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 Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
— APR 8 2011 Taxpayer Location Address•
C. .r+ Lutz, Mark/
GIBSON COUNTY AUDITOR HAUBSTADT IN 47639.
11311 •
Mark/ Lutz , . Mill ifiI]M11I1111-II II] II nlll[I II_II[II IIMI[1111_III I11 [IIII I I II II
11357550E
Haubstadt IN 47639-8833
State Parcel Number legal Description 1I 1 III 1II 1F1L 1FII It It I lI l FIIIt l LII l In III IIII II l I
26-23-07-200-001.414-024/ PT ENE 7 4 10 .815 AC• D-9
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.
`, e ' r
O'. I Fist Middle . Last
Mack A h 011y ' Lu+7.
Mailing Address(number and sgcct.g ,s 4,and ZIP code) R Same as property address
It 351 .SoE ilti.) aaA 1 1 I 4163E .
. .
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 1 Si ature Date
•
/ 5'� rt"' a
;e \ CLAIM FOR HOMESTEAD PROPERTY TAX
��A��� CREDITlSTANDARD DEDUCTION
'��,,� Slate Fo�m Sai31R215-92)
,.�: .
INSTRUCTIONS� See re�e�5e 5ide lor7iling inslruclion5.
FORM
HC10
YEAR
I�f
I(6Ve) � � certily Ihat on Ihe iS�y°of March. 79
�) occupied s our princ Ihe followi escribed real property for which a Homestead Pwpeny Credil is q�eb�`ai J
I We owned ��
( 1 ❑ Are buying under coniracl AUDITOR
❑ Have a bene!icial interesl in Ihe enlity �ha� is liable for Ihe properry taxes on the properly and thal owns Ihe property or is buying under a conlracl.
' `I '+t , �� � � � ' -- � CONTHACT RECORDED �� �
�� buying on conlraci. Fee S�mple o'a'ner'S name
Remeder's anke where coniraci is remrded Fecortl number Page
Counly
Pa�cel number
,. � .-.,._.
TownShip
Legal tlescripno�
PROPERTYDESCRIPTION � �. �: � • -
Ta.nAg tlisy�llnty. rown. townsnlp�
�ny - u \71ti� � c�
II a�+'/ port�on ol Ihe resitlenlial ;Imdu�e or ihe lantl not e�ceeding one � 11 acre ihal immedialety surrounds that siruGWre is used to produce income. desRibe ihe use and porlio�
o� thg pmoerty uGlizetl lo protluce incume.
c�� �3-o�%�3a�-lx>/. ��Ua�
' - � � � ' " � - � PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Ccunty Townshfp Counly Township
.�reby certify ihe above slatemenls are Irue, correct and complete. Sgn o� claimant
Atltlreu (number an0 streei. aly. siare. ZlPCOde) ��� � /� �
' ASSESSORUSEONLY� �� ' TRUETAX - ASSESSED MOMESTEAD NON-RESIDENTIAL�
� . VALUE VALUE � VAWE VALUE
Land nol exceeding 7 �one) acre immedialely �
surroundingresitlen�ialimpmvemenis. (�)
Olhor land (p) � .; : .
: :'L�'�_ ! . .
iotal land (line ] plus line 2) (3)
i ! � �
Dwelling �a) ��t x�} � h' ,�'
Residential improvements -' � � '
Gara9e �51 . �. �+�.;.i i'�';;����:i�,
, ` ,�,
_ � f:..
Other impmvemems I61 �'��=` ,4y'r �,'��' i+ _�_.
Total improvemenis (line J th�ough Ilne � (7)
Total value (line 3 p�s line � (g)
1 hereby cert��y the abo�e is Irue. correci. and Sgnature ol Assessor Daie signea
complele.
Ve�ilying ac6on - Sgnature o� Auditor . Date sgnetl
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