Homestead_Atkins • STATE IORM 5!'4.IR_/Hrrl TU:tSn1E11 POLY}IA
APPROVED BY STSTE BOARD Of Men t.n N PRfgtmm BY TIE DEPMIN/FYr(4 LOCAL rovEtNMrNt FINANCE IC 4.I.I-ra.1
Gibson County Auditor
•101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
mole 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 am eligible to receke the
benefit and to provide additional identin'int information necessan'to allow county government to better monitor homestead
filings.This information will he kept confdernial 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Atkins, Lori
_ - `°-. HI llox 166 A
Oakland City IN 47660 -
800
Lori Atkins
10054E 540 S - State Parcel Number Legal Description
OAKLAND CITY IN 47660-8566
Moll II t ttII tt t�r�tt�tr�t tIIt� 26-20-02 403-000.002-003 020-00002-00 PT SE 2-391 AC
PART 2:TAXPAYER 1NFORMIATION
Owner I First Middle Last
IR nn 114k , In
•tg Addiess(number and street,city,grate,and ZIP code) —–- -- -- -EtSerne to property oddrea
100521 E , Sg0S, CaKlahcI 2,t-1-�}1 � IN
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sat
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 -late
Spouse Signature Date Telephone
PART 4:ADDITIONAL INFORMATION
S
A
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473(R51 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
C10
I (We) & -)121 (? (;(-/ ,�,f ! /1 - certify AM A & Jyob March, 20
1 (We) occupied as our principal place of residence the following described real property for which a Home III Property T WE it is hereby aimed:
)_7 7
❑ 1 (We) owned ❑ Are buying under contract 77 1 -1 _ _
Have a beneficial interest in the entity that is liable for the property taxes on the property and that
owns t tie propertqor 'cs'buyfhg under a contract
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
7 -PROPERTY DESCRIPTION
County
'Imnship
Ta own, to III x�8
Parcel number
Legal description Is the property question:
S`ig /natur of claimant
b - o'2 - 0 0 �I property ❑ Mobile Home (I.C. 6.1.1-7)
5,? 1
If any Portion of the residential structure or the land not exceeding we (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
Land not exceeding I (one) acre immediately
P Rd P E RTY OWNED BY CLAIMANT I N OTH ER'C6U NTI ES
County
Township
County
Township
I hereby certify the above statements are true, correct and compete.
S`ig /natur of claimant
,.6tress in fa
-0 Mmslr�cw
Land not exceeding I (one) acre immediately
'ASSESSOR, USE,ONLYI.,�,
-;��.TRU E TAX
ASSESSED.VALIJE
`VALUE
xNOWRESIDENTIAO',-'*--,
VALUE .le
2A T jqp*�. 9FXTV�
`.VALUE
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other )and
(2)
Total land (fine I plus line 2)
(3)
Dwelling
(4
'r
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (fine 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
-STANDARD. DEDUCTION ALLOWANCE i :;Z -Wt-
20_ Pay 2O_
Lesser of 1/2 Homestead
S
Valuation or $6.000
Signature of Auditor
Date signed