Homestead_SimpsonCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 IRS / 10-01)
wta Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
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I (we) �r(JJGU K 1, y r I N=A C) jN c . heA
prtfy that on t of Mar6. 2P�
occupied 3ed real propirty for which a Homestead Pr6pert
I (We) s our principal place of residence the followi d
❑ I (We) owned El Are buying under contrail GIBSO.'4 COUNTY AUDITOR I
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 under a contract.
NTRACTRECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
County Tmnship
County ToAmship
Co Tcwnship
I
Taxing district (city, to
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ber Lfo- de
I
ption s the pro in question:
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e, I eal property ❑ Mobile HMO (I.C. 6-1.1-7).
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If any portion of the residential structure or th-e-End not ex ding we (1) &e that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
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SSESSE V E
County Tmnship
County ToAmship
I hereby certify the above statements are true, correct and complete.
Si atur ant
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SSESSE V E
HOMESTEAD
NO itESIDENTI�AL
iteVALU j�
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a6-- VAL
Land not exceeding 1 (one) acre immediately
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surrounding residential improvements.
Vill
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
NEW M®R
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
di
STAFE FOIn OtW OttMtui 113:ASORIR FORM IS-1A
APAIwpDal'I FT aos.o OF VnFNK:Rt PRESCRIBED NY R2 WlARIAL1 Or LO:LLCOstR]IDSI IWin:IC et:r4i
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNER&_
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 hoinsRnd fraud Homestead fraud causes higher tax bills for ell:therefore,
1 , HE.\ 1344-NNW requires taxpayers who nr_ive the homestead standard deduction to verify that they are eligible to recehe the
benefit and to provide additional idenuPoim: minrmation rte:emr to allow county em'cmment :o better rrRmimr homes cad
filings.'fhb.information will be Lein confidential and can only be-accessed by authorized county officials.The Department of
Local Government Finance trill Ire this information to o.utle tools that will help county officials eliminate homestead fraud.
APR 2 0 2012 PART 1:PROPERTY INFORMATION- - .
Taxpayer Name Location Address
C.'J N Simpson, Damian/Stacy
708 N CENTER ST
GIBSON COUNTY AUDITOR - FRANCISCO IN 47649
1479
II III I I.Boll D 111 BII IDII "III I H11_11.III DI II_ D 11111_111 IStacy Simpson
108 N CENTER
FRANCISCO IN 47649
. State Parcel Number Legal Description
26-13-20-101-000.311-005 SHOP ADD 31PT
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.
1 PART 2:TAXPAYER INFORMATION - .
zr I First Middle Last
(Si (14 DOWN/ s ►m P sod
Mailing Address(number and street.city.state,and ZtIPcode) it Same as property address
fd150/
Spouse First Middle Last ,
Mailing Address(Number and street.city,state.and ZIP code) n Same as property address
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
I I I I I I I State
' 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.
Owner I Ore �d�V� D e
PART 4:ADDITIONAL INFORMATION - -` .
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