Homestead_Potts MUTE FORM 5151 Rn r',Tat TRFAtin[ER'OEM TI-IA
.APPROVED BYMiVE 13.11ARDOrAMPONTS.2100 PRnyLAImmm BY DIE DEPARTHEW OF LOCAL(XWIENNr%r FINANCE IC4-1.1r4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sundial deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ester 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 honlcaead
filings.This information will be kept confidential and can only he accessed by authorized county officials.The Depanment of
Local Government Finance will toe this information to create tools that will help county officials eliminate homestead timid.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Potts, Brenda S
118 S Vine
I lauhstadt IN 47639
3112
Brenda S Potts P o (1,04_ I I
118 S Vine St C' State Parcel Number Leaal Description
HAUBSTADT IN 47639
26-19 31-303-000.407-009 013-00407-00 ORIGINAL PLAN 229/230
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
Owner I First Middle Last
SUrLL I?o++s
• •ag Address(number and street,city,state,and ZIP code) -E Same as property address
1 I g S . LJ ,I nC SE*
Spouse Firs: 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 Pan 4 below)
_-
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 1 Signature Date
( )
PART 4:ADDITIONAL INFORMATION
•
CLAIM FOR HOMESTEAD PROPERTY TAX L FORM
CREDITISTANDARD DEDUCTION HC10
i-.-te Font, 5473 (R71 54M
P'rscnbed by the DepaMient of Loral Gove ninerd Firance
INSTRUCTIONS: See reverse side for Ring inslrucfipns. gJ
(we) _ _ certify thaflxt-dAJd;qAarrh, 20
I (We) occupied as our p,ri��ln..,,,ciip""�))al place of residence the following describer! «v]i proper! for which a Hortrstead Property Tax Credit is hereby claimed:
I (We) owned I�SI ire buying under contract
Have a benefici al i /terest in the entity that is liable for the property taxes on the property and that owns the ltyLa� �gY¢ng,lgtllOiCContracL
tf
affice where cabal is recorded
Record number
Page
PRbeeRry oes t>n c: -
Cmatty
Tciwstip
T (cdy, • t )
Pared
Legal i 4 the WOPe le ti
queson:
-
I poporty ❑ Mobile Home (LC. 61.1 -7)
If any portion of the residential svutbne or the lad not mmseeVog one (1) Mat.t].!1••)andr�y snmtaMs dud ffi>x9xe is used to produce irmne, describe the use and p rbon
d�-� o amdrx a incerne. as � ��
r VALUE :�
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.... . °. w •'. N:
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..', °•„• ?- pROPERiY R1
- pNED,8Y CLAOAANT. BI OTHER COUNTffS::'' - x �• - - -' -7.
County Township
County
.'
Township
I hereby certify the above statements are true, correct and co nplete.
re ' mart
wats ( number and street city. state, ZIP code)
- - ASSESSOR USE ONLY -, '
'n
�•` TRUEtTAX ,
ASSESSED VALUE
HOW:STE AD
- r{ i
t lx VALUE'
(AT 100X OF TN
. VALUE...., '
r VALUE :�
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.�,.,: ,: . •,. _ ..;t'
Land not exceeding 1 (one) are inrnediafely
surrounding residential improvements.
(1)
',t,....... Y "`r
Other land
(2)�
Tdal land (lime 1 plus The 2)
(3)
Dwefling
(4)
Residential improvements or Annually
r "
Assessed Mobile / Manufactured Horne
Garage
Other improver tenbl
1(s)
Tdal'vnprovemerds (fine 4 thrvxrh 6r - Aj
!
,(')
1
Total value (line 3 plus Im 7)
(g) I
III
—._ ___._____— _.___J
1 hereby certify the above is true, cared. and i Sambre of Axaessor I Date sired
complete
Vailyig ad= - Signabae of Zwarw i flaw —y—t
20 Pau 20 = ______.______ —____! ^•
Lesser of 1 R Horneslwd
Valuation or 53.5.000 S
silahre of Audtor