Homestead_Page . STATE FORM 53b0(R1t 610) TREASURFA FORM TS-1A
APPROVED BY STATE BOARD OF ACCOUNTS.EON . PRESCSUBLD DYTIEUEPARo4eT OF LOCAL CAVEA\MEYT FINANCE IC 611-221.1
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,
FILED HEA 1344-2009 requires'taxpayers 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
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 infomlation to create tools that will help county officials eliminate homestead fraud.
MAY 2 2011 - PART 1: PROPERTY INFORMATION - .
C rc Taxpayer Name Location Address
Page, Clinton N/Julie
GIBSON COUNTY AUDITOR - 4286 E SR 64
FRANCISCO IN 47649
1130 1110 IIIJL 111 III 1111 011111111 ll IluI lIII I u l(_ u l DI till
I I_II III Clinton N Page
4286 E SR 64
Francisco IN 47649
• State Parcel Number Legal Description -
26 12-14-400-001.521-004 CPT SE SE to 210 1.5424 AC
t/ J -
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
•, I (� First Middle Last
.'1` `thn \\•••••- 6.....\Y1 de. o
Mailing Address(number and street,city,state,and ZIP code me as property address
AL4 Erik S*o Vc Loki Ranciaz 410-i9 .
Spouse V ake First / f l e S Middle Pa e Last
' 'Mailing Address(?ember and street,city,state,and ZIP code) 11r//\, • 0 Same as pruperty address - - —
Ea aaje ct (Dt-\ N -toryktu unci2,9 -
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 Signa Date
4 t CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
S State Form 5473 (R5110 -01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
M YEAR
FORM
HC10
CERTIFIC,4MQN STATEMENT-,
-- = . PROPERTY'DESCRIPTION -
CountyM T
Toxnship �
I (We) certi
t ih 1st o 1a h
I (We) occupied as our principal place of resideqte llow ing described real p ,rty for which a Homeste
top y ax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
MAR 12 2002
ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buyin nder a contr t.
Is the properlly m quuVion:
x4`.:a =. -, ;;.to- : h�zT s': ',. r_ �".:w� q .c -•, :..w s "'< CONTRACT: RECORDED.: ~:;_ ti :�_�"'�
IBSON CC liN1= i _ -
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
land not exce m
mg one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
- i
-- = . PROPERTY'DESCRIPTION -
CountyM T
Toxnship �
�' T
Taxing district (city, town, township)
I ber L
Leg c
criptio I
Is the properlly m quuVion:
LLLR61 property ❑ Mobile Home (I.C. 61.1.7)
If any portion of the residential structure or the l
land not exce m
mg one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
i.6 4a4 /
//t4 c
PROPERTY OWNED BY CLAIMANT. IN 6TH ER "COUNTIES
County Toxnship County 'Township
1 hereby certify the above statements are We, correct and complete. Signs r f claimant
U
Add r (number nd street, city, state, ZIP P iT 3 � �
.
rtix� 4 rASSESSOR USE ONLY SJRUE TAX rrt _ 'ASSESSED VALUE HOMESTEAD :- r� NONRESIDENTIAL =•
_.VALUE_ AT_100 %OFTTV _ - ,VALUE4 - T i. :i.�'VALUE •'a t'',p- -
Land not exceeding 1 (one) acre immediately -
surrounding residential improvements.
Other land (2) - ""•" ,r„'+;
Total land (line 1 plus line 2) (3)
Dwelling (4) P' C; sa.•l '7r �.
Residential improvements
Garage 6_?
Other improvements (6) - —` -"
Trial improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
1 hereby certify the above is true, correct, and Signature of Assessor Dale signed
complete.
Verifying action - Signature of Auditor Date signed
3_ - �- :'STANDARD.DEDUCTIONALLOWANCE .. .._"'n"
20 Pay 20_
Lesser of 1/2 Homestead
Valuation or $6,000 $
Signature of Auditor - Date signed
(,J 3- ) a- a,
.
rtix� 4 rASSESSOR USE ONLY SJRUE TAX rrt _ 'ASSESSED VALUE HOMESTEAD :- r� NONRESIDENTIAL =•
_.VALUE_ AT_100 %OFTTV _ - ,VALUE4 - T i. :i.�'VALUE •'a t'',p- -
Land not exceeding 1 (one) acre immediately -
surrounding residential improvements.
Other land (2) - ""•" ,r„'+;
Total land (line 1 plus line 2) (3)
Dwelling (4) P' C; sa.•l '7r �.
Residential improvements
Garage 6_?
Other improvements (6) - —` -"
Trial improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
1 hereby certify the above is true, correct, and Signature of Assessor Dale signed
complete.
Verifying action - Signature of Auditor Date signed
3_ - �- :'STANDARD.DEDUCTIONALLOWANCE .. .._"'n"
20 Pay 20_
Lesser of 1/2 Homestead
Valuation or $6,000 $
Signature of Auditor - Date signed
(,J 3- ) a- a,
3_ - �- :'STANDARD.DEDUCTIONALLOWANCE .. .._"'n"
20 Pay 20_
Lesser of 1/2 Homestead
Valuation or $6,000 $
Signature of Auditor - Date signed
(,J 3- ) a- a,