HomeMy WebLinkAboutHomestead_Bollin STATE FORM`J'rvIR_/E-•I TREASURER FORM TI-IA
APPROVED aT STATE BOARD OF ACCOUNTS."TEE Ptn][RmmnY TIE DEPARTMENT OF L(ECAL CAVERNMrNT FRANCE resLI-r4.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
l` PRINCETON IN 47670 Individuals and married couple,are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than eser for horn stead fraud Homestead fraud causes higher tat bills for all:therefore.
i • HEA 1344-7009 requires taxpaven who receive the homestead standard deduction in verify that they are eligible to receise the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kept contdernial and can only he accessed by authorized county officials_The Depanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Bollin, Simon
I
\ 501 Brownlee AVE NII V Princeton IN 47670
749
Simon Bollin
501 Brownlee AVE State Parcel Number Legal Description
PRINCETON IN 47670-1213
�t�t t��tt t�t��ttittt��� ��rr�t�rrr��t t��r�� i��rr�ri 26-12-07-101-003.593-028 /019-03593-00 FOREST PARK 17
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 , c
Owner I First Middle Last
S. AlOA P. fin // n
�T�Address(number and sates,city,state,��aa/nd ZIP code)j� O Same as property address ,
t5Of 3T )ta31'C A G 7.r%1,Ct-fd✓t ZU 417li70 - j 5y't"
Spouse First Middle Last
Mailing Address(Number and street,city,state.and'LEI'code) ❑ Same as propeny address
Social Security Number(last 5 digits) !rivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
star.
PART 3:CERTIFICATION I i '
•
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 $i'/ �� Date
•
�
R, CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Slale Fwm 5473 (RB / 4-03)
Presnibed by Ihe Department of Local Govemment Finance
INSTRUCTIONSr See revcrse side /orliling insln�ctions.
�a� FORM
HC10
YEAR
I(We) �/! R.Or \ u�iQ'`C.{/�'1 certi(y that on the 1st day o( March, 20_
I(We) occupied as our prindpal ptace oT residence the following desaibed real property for which a Homestead Property Tac Credit is hereby daimed:
n I(We) owned ❑ Ne buying under wniract
�ave a benefidal interest in Ihe entity Nat is liable for the property taxes on Ihe property and ihat owns the propeRy or is buying under a wntraU.
I( buying on conVaa, Fee Simple ownefs name
County
reWrCed
7o.mship
sWqura w the land na axceeCing one (7) aaa
ce income.
Remrd number � Page
Taaing Eislrict (tiry, (own, fownship)
I Is the property in quesUon:
� ❑ RealOroperty ❑ MobileHOmo(/.C.67.f-7�.
surtounds that suuaure Ls used to produce income, describe tlie use and poNOn
SgnaW re af Pud'Aw
20_Pay20_
Lesser of 1/2 HomeStead
vaivaLOn a 535.000
5