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Homestead_Wilhite SLATE FORM 5350(0.)/&1% TEERSURF/FORMISIA APPROVED BY STATE BOARD OF ACCOUNTS.ROM PRESCRIBED BY TIE DFPARTMEST OF LOCAL GOVFM‘MENT FINASI(E IC 6-1.1-224.1 • Gibson County Auditor IMPORTANT NOTICE TO HOI%'IESTIEAD PROPERTY OWNERS 101 N. Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes S Princeton,IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore, F I L'D HEA 1344-2009 and provide requires additional taxpayers who receive the homestead standard allow county to verify that they are eligible to homestead the benefit and to proide 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 Dept-anent of Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud. PART I: PROPERTY INPOR.ALA1'ION-; ?> APR 11 2011 TaxpayerName. . Location Address Adcock, Dusty UKriistofer B Wilhite , v \ 0 CR 1050E GIBBON COUNTY AUDITOR o OAKLAND CITY IN 47660 1440' n Dusty L.Adt:ock II I�IIiiIllI DIII _VIII III DI .II�IIDII_II I III�II)III�i�ll�ll Ina IlUI IIl.11I II 209S1050E '\ ' Oakland City IN 47660-8623 ,_.. State Parcel Number / Legal Description ' 1IIIIIFI6ntiull'1II111I1'IIIIIIIIII1IIIFllllllll ✓ - r 26-13-11-400-000.642-OOEI —arNE sE 2.+..2.g.1,7a AC' - 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 . • f . - . . . . ` G.. / First Middle Last . S Aynn . Ahco c_-ta) M." •g Address((num. and )cett.city,state,and ZIP code) 'g Same s_ property address / - Spouse r_ / First Middle 1 Last �G,Y;S�t�► 6 ranol lJi ylcp 'Mailing Address(Number anti stmt;clry,state,anti ZI(code) - - ,�Q!\J/� Jame as property address _ - ' 1 - ' • - -' 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 (R614-03) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse,a'I'de for filing instruction I (we) \ I / kA -') 1 - - %- _I% I I-, I (We) occupied as our principal place of siden, ...... I described real property for whrdlaT ❑ l(We)owned �e ❑ Are buying under con-- Wave a beneficial interest in the entity that is Ii.ole for the property taxes on the property and that If buying on contract. Fee Simple owners name Recorders office where contract is recorded FORM HC10 16f March, 20 is hereby claimed: buying under a contract. Record number I Page �§' �RWWWSM--�,,0-PFZOPE IRTY, IDESC RIPTION Coun to I Lism - Township Taxing district (city, to", t Ishi nl�cmble' Pa M-n- Legal description Is the props rIV in question: (2421) rr [X'Real property ❑ Mobile Homo (LC. 61.7 -7) If any portion of the residential structure or the land not exceeding one (1) am that 3unds that stricture is used to produce income. describe the use and portion of the property utilized to produce income- -1,3 -cco. 6616? -X4 AN16THERtOLINTIIESZ;T,��,qAf County Township County Township I hereby certify the above statements are true, correct and complete. Si t r of I cm, t rr number and street, city, state, ZIP code) V , e zi 20 _ Pay 20_ Lesser of V2 Homestead Valuation or &35.000 S WgS- kiii V ALU NHOMEST EA-D" adN-"�giR6E—WTjXj 90 %'0 F -T r V VA L U E Land not exceeding 1 (one) acre immediately surrounding residential improvements. Other land (2) Z Total land (fine 1 plus line 2) (3) Dwelling (4) IResidential improvements Annually or Assessed Mobile/ Manufactured Home Garage (5) .74 IRWIN- �1- KNOW" 5 ON?- MARIO Other improvements (6) Total improvements (line 4 through line 6) (7) Total value (line 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 20 _ Pay 20_ Lesser of V2 Homestead Valuation or &35.000 S