Homestead_Allen (5)�-�1
�; .` �.
���
CLAIM FOR
State Fortn 5473 (R614+
Prasaibed by Ne DepaA
INSTRUCTIONS: See
fEAD PROPERTY TAX
DEDUCTION
of Local Gavemment Finance
for filirg insbucfia�ns.
I(We) � ri � r certify that�odry�tje 1sl day f March, 20
I(We) occupied as our rincipa� place oi residence Ihe following described real property (or which a Homestead Property i��redil is ereby daimed:
❑ I(We) owned ❑ Are buying under contract GIBSON COUNTY AUDITOR
' Have a benefidal interest in the entity that is Iiabie for the property taxes on the properry and that owns the property or is buying under a contract.
If buying om m�tract, Fee Simple owners name
Remrdets otfice where conuaq is recorded
County Taxnship
Pa r� D 1�� 1�� e
If y portion ot N8 tesidential sWCWre w the nd no�
ot the properry utilized tu protluce inwme.
one (1) aae
Rewrd number � Paga
Tacing district (dry, tawn, townshiP)
Ilsihe propertyin quesUon:
� ❑ Real property ❑ Mobila Homo (I.C. 67.7-�
surrounds Ihat swGUre is usetl to produce income, desvi6e Ihe use antl portbn
�'��'�x. `;` ' ��r -- i�'� ".'�''TRUETAXY-r ASSESSEDVALUE ' HOMESTEAU; ' NON=RESI�ENTWI�"` ri
��, � �ASSESSOR 11SE ONLY �- � � }�' yqLUE� 7� � �/1T�100 /o OFTfV� ���2VALUE� ��t ��.��� � VqI,UE '�€
;?�'��.. +�G'v'� � 4�a r.Z�, xt x'. a � r��k�. ��.r'id.l.,:sw..., Y. �C'.;�. '�ib'o},
Land not exceeding 1(orte) aae immediatety � €? �,���,���`R i�`�:<���g��;
surrounding residenGal improvements. � � ��'< r£� ,-.t
� s f�����,T ..+��^:
O�her land "�� '°`r' ' q'=`
�2� � � -`�,i-�� r�
�
,,. �.sb�.w.r-,_�.s'.�
Tdal land (line 7 plus line 2) (3�
� ;�•� a ���r:vx�= v:..: �:.
���"` .���`�S�
Dwelling (4) -�- �.�q. �-�'.,,� .. �, r
�Residential improvements or MnuaOy � Y� y '' -"
_.�.-,.a.� . -m'�cu::s� �r.�_+°i
Assessed Modle / Manufac4ued Home Garage 5 ����'c+�''`���i� ��. `� �� f`^'
( ) �:`r`�� : � '�`� �
Other improvements (5) ,�c: �x_"'�� ;4 �
- � sw"-�s�S`fi:`..Y��'�
Tdal improvements (line 4 fhrough line 6) (�)
TUaI value (line 3 plts line n (g)
I hereby certi(y Uie above is We, coned, and Signature otnssessor Date signea
complete.
Verifyiig action - Signature of Fwditor Date signe0
�c2 ,f t+'*-- �:..,,�; c. '�,. � �v . � -�=..
. ���
.. S: t.. ..- ��:''„�"�...:::etr.! �i�'�5���'� .,u,;.ST/WDARO;DEDUCTION�ALLOWANCE __c.,s;;a,`,�.�.�.� .t v?j:.§",�-"�_��c1�Sx��e,—,,,,f
20 _ Pay 20 _
Lesser o� 1/2 Homestead
wawauon w 535,000 S
SignaWreoflwddw - Datesigned
STATE FORM 5)569 (IU/8-10)
TREASURER FO0.T1 TS-1 A
APIRO\'FD BY STAiE BOARD OF ACCOUMS, 3009 PRE$CRIBEp gY THE DEPART¢\T OF LOCAL fA\'ERt.'NE\T FI\A\CE IC61.1-2?-8.1
' / � 1 , / . , 1 � � 1 � , � ':i..C..,," ..
Individuals and married couples are limited to one homestead standard deduction. As the receipt oT this
deduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
�•causes hig6er tax bilis for all; t6erefore, HEA 1344-2009 requires taxpayers who receive the homestead
standard deduction to verify that the}' are eligible to receive the bene5t 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 be accessed by authorized county officials. The Department of Local
Government Finance, will use this information to create tools that will help county officials eliminatc
homestead fraud.
Tuoaver \ame
�t�TOn L Allen
Complete and relurn !o:
Owner 1
yYjY►4o�u
Matling Aaaess (wmEer ene sveel. ab. st
l�8'7 �. �
� :
MiEEIe
Sama es proparry eCNess
�,.
�
�„
f� C. L �,cJ
a.trer (we� so�rr h Pa�+<
Sama ae proparty aa0rets
Drrven Litensaf5lata ID NuiMar (last 5 tliglb) � �� � OVrer (dease sperAy in Par� C balvx)
Last
Each undersigned certifies, under penalry of perjury, that the above and fore9oing information is true and correa 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 dedudions unlawfully, he or
she may be liable for back taxes and substantial financial penalties.
Owner 1 Signature Date Telepfwne
�'1�� �`,�- �.�.`� / I- 2- 2 o i�, ( �
svw:a s��:�.a
S .
-�
RNIATION•;'; �, - •?_�,-„i;, .
• .
j� _ �