Homestead_Bolden (4) STATE FORM 5356A(UIbWO) TREASURER FORM TS-TA
APPROVED BY STATE BOARD OF ACCOUNTS.MN PRFSOUBCD BY THE DEPARTMENT OF LOCAL OOTTa\MEVF:l4ANCE IC 6-11-224.I
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,
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
• PI 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
T
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
L- /V^/p PART 1: PROPERTY INFORMATION
APR 1 Taxpayer Name Location Address
2 20/1 , Bolden, Delaney UChris A/Kathy L
0.3 Robins 604 N HART
GIBgDN 00,, PR/ t�N 47648
674 AUDITOR
Delaney L Bolden 1101 ill 100�I�0110111011- II 011111110111 hill DIII101101110111 11011011010111110111
604 N Hart
PRINCETON IN 47670-1450 -
11Illl1ll1tilll'1I1'III' 'Itllttlltlttit�illtltlltlliitllttl�il State Parcel Number Legal Description '
26-12-07-102-001.145-025/OLD PLAN 126 PT
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
L. _:r l First Middle _\ Last•
Dee_ zvme ��L rlo� U��
Mailing Address(number and street,city,state,and ZIP code) m.S"ame as property address,
.- Mailing Address(Number and street,city,state,and ZIP ode), - '—D'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 I I I I I I I I sirs
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.
Ow I Signature • Date
•
A rt��4
?* ; CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDtT/STANDARD DEDUCTION
t�� � 51ate Fwm 5073 (RS / 70-01)
Presrribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side foi liling insWCtions.
� ��
FORM Y AR ;
Hc�o � b b'� I
� (�^�e) �� �, certifY th��Rhe��d��arch. 20_
I(WR) oaupied as our principa place of resid e the ionowing tlescribea real property (or which a Homestead Prop�; redi is here�med:
�/
LI�J I(VJe) owned ❑ Are buying under contracl
�1ave a benefidal interest in the entity that is liable for the property taxes on the pwperty and that owns� e�p[D �{y Q 6dyi�g�urMerra�onlract.
� �If3�U(G
s�c.'��ic�r�'.'ti'�a�XY'r''.;.1Tr. 2 =,%`•:.c ��.�.�'?:, ys,�:::1.C;t �,J'.:CONTRACT�RECORDED. , t i.,":... . � •. -:>1 - �-s . .
if huying on conVact, Fee Simple owners nama
Remrders ofice where wntraU is reoorded Rewrd number Page
Counry
Parcel number �
(1 \ � -0� ��{ 5 •-..�
Tavnship
Tacing d�Jlkt �cit�wq tawnship)
Is the property in queslion:
❑ Real propeny ❑ AAObila Momo (I.C. 61.
if any ponion of lhe residentlal sWCture w ihe land not exceeding one (1 � aae that immetliatey surtounds Ihat swcNre is used to D��uce income, desaibe Ihe use antl portion
a( tha propeAy utilized tn produce income.
r'4�".'�+:��"�-��'��"' ''-=� � � ��,. '� �'� � �' TRUE.TAX �' ASSESSED VALUE HOMESTEAD '" > �r�=.
r�- ASSESSOR USE ONLY .. NON RESIDENTIAL
Rf,�v+::;-R�•��.�-^�f_-."'�.a�°' ',�'_-.�_�..<�ia�r::e z:,_.....yya VALUE. � �.AT700YoOFTN '��-VALIJEy�:t�-z" � �^"VALUE.✓..��?•����
Land not exceeding 1 (one) acre immediately _ %i K ;,�� '� � � ` '� z �: �
surrounding residential improvements. ��) ��`� � 'y,��''y t� „ L:qr'�'� ; �.
c z'=:y`, � . X' ,� "
Other�and (p) -,. � .,^,
.r,r-:«i',". . r,`�'—,
„:�.,.-..f.:.:"'' �' '
Tqal land (line 7 plus line 2) (g�
i.� nv
DwelGn � .. � F1;a5•sE,�•a���5�'`'�� :i
ResidentialimprovemenLS 9 (4 �`���°.�.jci"�:°�r:`�T`"�^�is;�"'3
:-�-"+�� �,�; ��';�-
Garage �5) .7..,,y�y 4���-`,c�- �,:�,?-.as
� r.i» � _', �_
x1 '-0 �..`� r's��:.t
Olher improvemen�s (6) i.,: ,, „-�` _
a11�.:mi �,
TUaI improvements (line 4 through line 6) (7)
Tctal value (line 3 plus line � (g)
1 hereby certiy the above is true, correct, and Signature otnsseswr Date signed
complete.
Veritying action - Si9�ture oflwditor Date signetl
�f„_1.."'"t'r�-�a r.�-F'n....' ^-'. y-73"''Y3I7.. . _ .,,A _. . ,ta . _
,n..�..__rr `�'-t�e. �-3r -,v-tSTANDARD:DEDUCTION��ALLOWANCE s��:�s.t,.�-i..-.a.�_ a ,; ��� �.i�.i`.:1��`',":
20 _ Pay 20 _
Lesserof 1/2 Homestead
Valualion or 56.000 S
Signature oflwdrior Date signed