Homestead_Hale (2) Ir
MATE FORM!Meg IIC/,r.l TPFASUIQ FORM 7.3-IA
/` APPROVED BY ST ATE 110Wrt6'<W L%T',pr rtrJlTIBm BY THE nrMRT\terrrrt LOCAL G(McLYY.EFT FINANCE IC 4-1.1-1:4.1
1 101 N Main on County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101
PRINCETON IN 47670 Individuals and married couples arc limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than tier 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 recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kepi confidential and can only he accessed by authorized enmity officials_The Iklunntent of
Local Government Finance will use this information to create tools that will help canny officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
—. Hale, Jack/Carol
RI Box 113
Oakland City IN 47660
4788
Jack/Carol Hale
7774E 300 S State Parcel Number Legal Description
Oakland City IN 47660-8508
I I I III I I I I I ( III I I I I I I I I I 26-13-28-100-000.242-004 002-00242-00 PT E NW 28-2-9 1.60 AC
t o ut t tit n tri li it t t to it r to t u t u C-1 D-6
Spouse First C-6--'1,0---e /Y Middle Last
Mailing Address(Number and street,city,state,and ZIP code) i /gSame as property address
7777.f�3 Dos c °"`d"4 1---4 e VPI6a
-
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.
•
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
1 CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R6/4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
' `,i_ CERTIFICATION STATEMENT-±. > °jx'�.,isi� . _s1t�r't
I (We) �.(. certify that on the 1 st day of March. 20_
1 (We) oocupi place of residence the following described real property for which a Homestead PrOrR Tait Gena�ereby claimed:
❑ I (We) owned ❑ Are buying under contract /I _
Have a beneficial interest in the entity that is liable for the property taxes on the property and that
rs��' CONTRACT, RECORDEDt.." �)" a� ;,�= �"s'+��= ;r�,�:��.�'ti���y"'.
If buying on contract, Fee Simple owner's name
Recorder's office are contract is recorded Record number Page
PROPERT7Y: DESCRIPTI6N9%: r` L±; r�T,:" �2{ �t'- ��i� .r,:,�`�,,'�y'.rv.ir)ls� ?�.a.:
;County
Tonnship
I hereby certify the above statements are We, correct and complete.
Taxing district (city, town, township)
u r
des of
1' 11 ^
Is the property in question:
surrounding residential improvements.
�4.i 'p(�
❑ Real property ❑ Mobile Homo(/.C.6f.f -n
If any portion of the residential structure or the land not exceeding one (1) ace that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
4( nc-/ - -
QD -OLt� • C� -!/��
zoo t'<a' OM ? P.ROPERTY;OWNED',BYCLAIMANT;IN
County Township
County Township
I hereby certify the above statements are We, correct and complete.
Signature f claimant
r
lgdnumb street, city, state, ZIP code
u
SSESSOR�U ON Y
¢ U AXE
ASSESSED O i
ATx100 °A OF'TfYA'
� HOMESTEADD
DW UE
t ' oNONAESIDENTIAL I -�
W ,'-WA�UE '�
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)u_J
Total land (line 1 plus line 2)
(3)
Dwelling
(4)�
n ,.xx•sW A•r _z
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Gera a
y
(6)
-F,;3 '�rtr a`
5!y ,( .i fas
rc�+5"{N V T 9A( M ��_
ARM-
Other improvements
(6){`�'
?'A'v)
F
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line n
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed