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Homestead_VickersCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR CREDITISTANDARD DEDUCTION HC10 t - State Form 5473 (R5110-01) � p Prescribed try the Department of Local Government Finance INSTRUCTIONS., See reverse side for (ling instructions. CERTI CATION TP E STATEMN-:;�, ; ", --INAAV 1`1 _ ._._... ._ate _XT�.-- :::- �.- ..�..�.:��_ I MIe) �' "- - C&AA ce y that on the�lsl ddey of March, 2 e occ as our rind al lace of residence the following described real roe for which a Homestead: Pr "o �'� (W) P P P 9 property rty r- ;; "JNyCVUNT�Yr UD�TGr; aimed: ❑ I (We ed ❑ Are buying under contract WHave 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. ss' X'; k. tC_ ONTRACT .,-RECORDED'.,r�'t- �',�`s'`"y "g,�rr!y„+?3ts "- i-`',4'•�`- „ri`he If buying on contract, Fee Simple owners name Recorders office where contract is recorded Record number Page �� � � �'( PROP .ERTY;O1NNEb'BYCIIAIM,GNTiIN,' OTHER” COUNTIES ;(�`0.�;,�� +3'�s °'�sz`=-y� -sR __D_ __. IO ROPERTY >DESCRIIoTION� :�.^.sa.�se`..�''=7(``•�av"r. ri''a�'- �tk"'"�?�.�F�',' Coun 106 Tavnship Sig tut claimant I / T 'ng di5 (city, fo , township) Parcel number O/ Legal description Signature of Auditor Is the pro rty u question: Real property ❑ Mobile Home (I.C. 61.1 -7) H any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion of the property utilized to produce income. �� � � �'( PROP .ERTY;O1NNEb'BYCIIAIM,GNTiIN,' OTHER” COUNTIES ;(�`0.�;,�� +3'�s °'�sz`=-y� -sR County Tavnship County T_nship hereby certify the above statements are true, correct and complete. Sig tut claimant I / ATress (number and street, Q uAa1 ZS ode) A tZ.0 C.1 o 4W I 3 Y ^j'' -�-1 $sS. ASSESSOR USE ONLY= '1"yt' -�' �s�,�TRUE TAX ,a 'ASSESSED .VALUE 4,0..=.:..� .r.."f': HOMESTEAD - - ..c+o.f -c :. INON -hi StDENT1AL i �r",.yVALUEa'', -s,�, ""'`i;�yVALUE. y `-. SAT 100_ %'OFTTV VALUE Signature of Auditor Land not exceeding 1 (one) acre immediately (1)t g«�u.,,at e '_` rr surrounding residential improvements. i.,y.�w'..3V Other land (2) Total land (fine 1 plus line 2) (3) Dwelling (4) mg 'k*T % t`� "Z 7. Residential improvements Garage .+ sE (5) g Other improvements (6) a� t in. Total improvements (line 4 through line 6) (7) Total value (fine 3 pits line 7) (6) 1 hereby certify the above is true, correct, and Signature of Assessor Date signed complete. Verifying action - Signature of Auditor Date signed .:' taaa�s' t•: t" r'_`", r- t- a- t' atCST/ WDARD '.DEDUCTIONiAL1OWANCE,i'r,''¢z. W. 20 Pay 20 _ Lesser of 1/2 Homestead Fs Valuation or $6,000 Signature of Auditor Date signed STATE FORM 53569(1718-10) TREASURER FORM TS-IA APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1 22-8.1 - IMPORTANT NOTICE TO IOMESTEAD';PROPERTY O.WNERS; It Individuals and married couples are limited to one homestead standard deduction. As the receipt of this 'eduction becomes 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 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 Local / Government Finance will use this information to create tools that will help county officials eliminate homestead fraud. , :4 e;« _,u.- - tiPART1:;PROPERTY,,INFORMATtON ;+Ila;; - 4,, , . w ••' tJ°k-fi `z, :I Taspa,.er Name Property Address State Parcel Number Leal Description: James R/Michelle R Vickers 0 SR 168 26-20-14-301-000,073-002 PT NW SW 14-3-9 .50 AC OAKLAND CITY IN 47660 Complete and return to: 111111111111111111111N11[11112111111111111111111111111 R 111E1111111 GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 -,,. >, : - ,_. '17.'7,- ', er Owner I First - Middle 1 ' Last �ativt eS O&CPasec m 14Cc u lJ 1 c k_et5 Mailing Address(number and street,city,state and ZIP code) Same as property address s Social Security Number(last 5 digits) Driver's License/State ID Number(last 5 digits) state Other(please specify in Pan 4 below) - i - Spouse First Middle Last • i1/�1Ch e,I 1c Rolle Utcxrs Mailing Address(number and street,city,state and ZIP code) 1 ri Same as property address q6(61 r 1 MailAW. &M (cu C1L )t �f 147176Z0 ; ti `-• _ " "PAST Z r i © t= w - ._ r 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. Omer 1 Signature Date Telephone Spouse Signature Date .h a.i-f;a.a. GT. �.. ,A, e4s: :n,wu'.mi.+.-�+ - -' -.. .4l ZR - _ m+ni>-s'<S.il'„i,;ms ,.a --n:>::G'Y�,`N..dS^_T:�.c I •r'er FILED NOV 5 2012 GIBSON COUNTY AUDITOR