Homestead_Hale a
SLATE FORM:135M tle fWO TPFANFIR FORM T3-IA
APPROVED By cl.art anterior Anent eaS.`nu PREYAIam BY THE DFPAR1WVT OF LU'AL r vERYMEKT Fa:A\CE IC 6-1.1-2:.1.1
• Gibson County Auditor
1 01 N Main Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
1
PRINCETON IN 47670 Individuals and married couples are limited to one homestead uandard 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 134-i-200c requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will he kept conEdential and can only be accessed by authorized county officials The Department of
Local Gmerruucnt Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Hale, Chris A/Allison D
6183 E250S
_ Francisco IN 47649
1839
Chris A Hale
6183 E 250 S State Parcel Number Legal Description
Francisco IN 47649-9063
26-13-30-200-000.244-004 002-00244-00 PT NE 30-2-912.12 AC
ILIttlltrtltlltttlttlliIIIIIlrtlltrtrlirrttlltltrlrrtlltrrrlll X 0-10
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 1 First Middle Last rk C \(`,5 fNA1e.
ag Address(number and street.city,state,and ZIP code)
0 ® Same as properly address
Sponse First Middle Last
Rtll-3cr\ 0 of
Mailing Address(Number and street,city,state,and ZIP code) 133 Same as propeny 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 Si Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
e4 CREDIT /STANDARD DEDUCTION HC10
State Form 5473 IRS 110-01) Prescribed by the Department of Locat Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
'•r': -' -=i - - 'CERTIFICATION STATEMENT'- pp
I (We) certify tha&E Re lstlda,2§00arch, 20
�) occupied as our print pal place of residence the following described real property for which a Homes"cpk� redit is hereby claimed:
(We) owned ❑ Are buying under contract [n,
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns y Intract.
°-0`.i_' stt� ,t+y" «:? ":',� -�• -. .ci ': ... ....� '. *,'.'CONTRACT'RECORDED
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY OWN ED BY CLAIMANT IN OTH ER* COUNTIES` -. , S;r r _...'' ".'v- "' `" °•'`'
- PROPERTY. DESCRIPTION,,:=
County
Township
Township
Toxin dislrtcl ( 'ty, town, township)
Parcel number c'
Legal description
Is the props in question:
nbcl- O Q `� -Oa
QDaI property ❑ Mobile Homo (I.C. 6- 1.1-7)
If any portion of the residential structure or the land not exceeding one
(1) acre that immediately surrounds that smict re is used to produce income, describe the use and portion
of the property utilized to produce income-
Land not exceeding 1 (one) acre immediately
,? -1.3 - o
� Daft
PROPERTY OWN ED BY CLAIMANT IN OTH ER* COUNTIES` -. , S;r r _...'' ".'v- "' `" °•'`'
County
Township
County
Township
hereby certify the above statements are true. correct and complete.
Signature or clai 'nt
ddress(number and 5treel state, IP code)
�?t,. -sue >> *st`f'r,�',i� :s, „•" i,:: xF`;^miuZ STANDARD. DEDUCTION ALLOWANCE - ..
s TRUE TAX ,
ASSESSED VALUE
HOMESTEAD'
JNON- RESIDENTIAL ° -r
�= ASSESSOR USE ONLY _ ''-
VA_LUEi
'AT X00 ° /a OF..TTV
`' - ``VALUE
_
VALUE a _
Signature of Auditor
Land not exceeding 1 (one) acre immediately
Date ned
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-
surroundingresidentialimprovements.
"`
Other land''`
(2)
Trial land (line 1 plus line 2)
(3)
t f Trig r ^.
Dwelling
(4)
r
Residential improvements
Garage
'' 4 �'ri+,�3,c- yr�"�r�
6
�
Other improvements
(6)
,; •n ... �,.
-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line n
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
�?t,. -sue >> *st`f'r,�',i� :s, „•" i,:: xF`;^miuZ STANDARD. DEDUCTION ALLOWANCE - ..
-''..• '' ..".`w •F*'�:,..'
20 Pay 20_
Lesser of 1/2 Homestead
S
Valuation or $6,000
Signature of Auditor
Date ned
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