Homestead_Elliott • STATE FORM 53500(41&IY) - MEASURER FORM MI
APPROVED BY STATE BOARD OF ACCOUNTS.31 Q vgEYMIBm BY TIE DEPARTMENT OF LOCAL GOVERNMENT F1NAC IC 6-1.1.21-8.1
,
Gibson County Auditor IMPORTAN NOTICE TO HOMESTEAD PROPERTY OWNERS
--101.N.:N!a1n.StreeLr- - 7 "Individuals and married couples are limited to one homestead standard d..-duction.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 sax bills for all:therefore,
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
a benefit and to provide additional identifying information necessary to allow county government to bener monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
I Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
JAN 6 2012 Taxpayer Name Location Address
C.O.N Elliott, James C
12298 E Harrison
GIBSON COUNTY AUDITOR
OAKLAND CITY IN 47660
1736
James C Elliott II�I�III��IIIDIIIII�IIII!I IIIthUI111101101thliii1=IIIQI-II_IIlIII!CII�ICIIII III
12298 E Harrison
OAKLAND CITY IN 47660-8100
111'll'lltt1111'1111111'111111"I111IIIIl111111111"1i111I"Ii1' State Parcel Number Legal Description
26-14-18-402-000.902-006 PT NE SE 18-2-8.7988 AC C-1
•
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.
',t PART 2: TAXPAYER INFORDIA Il N .
First Middle / [ Last
//_1
Sivufs lQ.. t Eli'. 014
Mailing Address(number and street,city,state,and ZIP code) gi Same as property address .
I)J.9g E4s+ 1-Lte-ir i Ses* Skid- , Ce..t.LA. cil. Li 1 I nl -d7 i.c0 o
. .
Spouse First Middle . Last
ETA -
-Mailing Address(Number and street:ciy;state,and ZIP code) - - [-Samc'as piopertiaddress - - — --
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
-I _ I . 1 '1 . I I 1 . 1- �JSw�
- - _ 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 Signature �-� Date
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R71 540
Proscribed by dw, Department of Local Govenwrowd Finance
1 ORM
HC10
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I (We) AzanW %— X AAAXe1o4 car* the aftTIM1=1 114—
1 (We) occupied as opal place of rmiderice the fillmotrig describeiTreal property for which a Homestead Pro claimed:
-1 1 (We) owned ❑ Are buying under contract
r oft ,
10 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the ww&ora" 6—ider a cuatract-
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Racordees ot6ce where contract is remrdad
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Record number
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PROPERTY DESMPMON--
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Is the popaity in question:
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'[:] Reel property
❑ Mobile Home (LC. 6,., -7)
H any portion of the 1 ounds dud structure to used to prod" vxxxne. deearbe the use and portion
of the property uhf®d to Produce incorne.
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I hereby certify the above statements are true, correct and complete.
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USE ONLY
TWE TAX.�'-,
ASSESSED V%WE
'AT
,,-`,H,0WlVkT,E,AD"-
400% OF
%
�WALUE
Land not exceeding 1 (am) acre immediately
sunuunding residential improvements-
Other land
(2)
Tdal land (Im I plus fine 2)
(3)
Dwe(rnm_
(4)
Residential unprovet, ends or Annually
Assessed Mobile Manu%dixed Home
Garage
io nw
(5)
Ober nprovements
(6)
TdW ffriprovements (roe 4 f1wough Eno 6)
(7)
Tcted value (fine 3 plus Am 7)
(8)
1 hereby certify the above is brue, correct, and
SgiatureafAsoessor
I
Data zgned
complete.
VWying adlon - signature of Auditor
Data signed
i,i ",STANDAFtDDEIMJCTIONALLOWANCEs ' X, 't
',Mk> R
20 Pay 20_
Lesser of 112 Homestead
Valuation or Sw000
Signature of Auditor Date agned