Homestead_Page (5) STATE FORM 53569(PJ/810) TREASURER FORMTS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2004 PRESCRIBED°YEW OEPARTMEVT OF LOCAL GOVERNMENT FINANCE ICS-t.1-224.1
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(mud.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
.. benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
IJ E D 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.
F I
PART 1: PROPERTY INFORMATION
— MAY-11 2011 Taxpayer Name Location Address
C Page, Vickie L
4475 E 200 S
GIBSON COUNT�TOR FRANCISCO IN 47649
4101
Vickie L Page 11111111_ ill II 11111111[000o I lull i l IF ii:ii 0If 11111 I U_II]lI_F �t
4475E 200 S
Francisco IN 47649-9026 . - - .
"IllllllllltltIIIII"II'II11I'11111III1111I"'I11111tt1Itlllll State Parcel Number / Legal Description
26-12-23-402-000.005-004/ PT NE SE 23-2-101.3251 AC 0-10
5
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.
- _ r -\___...., PART TAXPAYER I\FOR)1��1'ION •
O . _ 1 First Middle ._--_.. Last
__
Mailing Address(number and meet,city,state,and ZIP code) e [ Same as property address
y2l)c F. .200 S ln7r1C,SCo,, 1N 47&Y9
- Spo:u . - First[ Middle - . . _ Last
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
I _tee
PART 3: CERTIFICATION
Each undersigned certifies,under penalty of petjury,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 ature - Date
e�` vuq �' - 'J�✓�
a CLAIM FOR HOMESTEAD PROPERTY TAX- FORM YEAR
s; '= CREDIT /STANDARD DEDUCTION HC70
.� State Form 5 473 (112 15-92)
uu
INSTRUCTIONS: See reverse side for tiling instructions. T 3 r-4 1 jN,
1 (We) - v -- certify that on theWs78a^t MafLft!'9_
/oc�pied as our principal place of residence the following de ibed real property far which a Homestead Properrrjyy Tax Credit is hereby claimed:
�I (We) owned ❑ Are buying under contract D ' 1r�
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying un r a contract.
- CONTRACT RECORDED
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRI
County Township
Taxing Inct ty. town. ' ' )
O
NON - RESIDENTIAL
VALUE
r� ... er O Legal description
D
It any portion of the residential structure or the land not exceeding 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.
/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
y tify the atemenis are true, correct and complete. Signature of claimant
ress (number and street .. stale, ZlPCOdI
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2)
Total land (line 1 plus line 2))
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pis line 7)
(6)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
�ying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
Valuation or S2,000
Date