Homestead_TolbertCLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD / SUPPLEMENTAL DEDUCTION
State Forth 5473 (R13 / 12-09)
Prescribed by the Departrnant of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
rTT 71 -r--..
-
I (We) certify that I (we) occupied as my (our) principal
place of residen or am (are) buying the following described real property for which a Homestead Property Tax StanDKD @ucti"fPereby claimed
er contract on the date this application is riled, (date of filing). I (We):
C J. nay,
Own ❑ Am (are) buying under recorded contract (\
v\
❑ Am (are) entilled to occupy as atenant- stockholder of a cooperative housing corporation GIBSr(1y V
❑ Have a beneficial interest in the bust or the right to occupy the property under the terms of a qualified person8VAWgyr SUDITOR '
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
Named daimant (legal na7
Social Seam
Name of claimant's spouse (legal )
Social Secradty, number of claimant's spouse (last rice digits) Driver's license I Identification I
If buying on contract, Fee Simple owners name
Recorder's office where contract is recorded Record number
Page
•• - 'alwal BONN=
County
Township Tatang " (city, town, township)
Parcel number
Legal desorption
Is the property in estion:
OL / 0 ?9..34, Ad
EiRral property ❑ Annually assessed mobile home (IC 6-1.1 -7)
If any portion of the residential structure or the Wed not exceeding one (1) ace that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce Income.
-Oct - Y7 - Do /'00C), -2 98 -D/ 7
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
-Ski nature of claimant _
Ids
Address number and street, arty, state, and ZIP code)
7 S' J/ 7 G o
.f z'r'"7 E o ftZ
Land not exceeding 1 (one) acre Immediately
surrounding residential Improvements. (1)
Other land
(2)
Total land (11m f plus time 2)
(3)
'x— -.�•
Residentiallmprovements or Annually
Dwelling
(4)
�'.;- s• -* ;.a -;
Garage
(5)
Assessed Mobge I Manufactured Home
r
Other Improvements
(6)
y
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above Is true, correct,
Signature of Assessor
Date signed (month, day, Year)
and complete.
Verifying action - Signature of Auditor Date signed (month, day, year)
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any otherprowsm, the sum dare deductions provided in IC 6.1.1 -12 to a mobile hone mat is $
not assessed as real property or to a nanufacturad home that is not assessed as real property may not exceed
one -hall 112) of Me assessed vshm tithe mobile home or mamdxtumd home.
Signature of Auditor
Date signed (month, day, year)
C .7-
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Gibson County Auditor • IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS 0
101 N.Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial.then is more incentive than ever for homestead fraud.homestead(mud muss higher tax bilk for all:therefore.
HEt 1344-2004 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional idcntifrine irfim ation ncressars' 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 Depan:nert of
Local Government Finance will inc this information to create tools that will help counts'officials eliminate homestead loud.
- PART 1:PROPERTY INFORMATION
Taxpayer Name Location Address
Tolbert, John B/Esther M
11068 N SALEM LN
HAZLETON IN 47640
2491
Bryan Tolbert
1E11_11_11 11.11I Il]uviiiifiii ��
5249E 1075 N
Hazleton IN 47640-9308
tltllll"'III"'I1Irllll11rtll"Iltrllll'lll'llllllt1lll1llrtltrl State Parcel Number Legal Description
26-02-47-001-000.798-017 PT LOC 1-1-1 79.36 AC
FILED
APR 26 2012
This form MUST be returned to County Auditor's ofpce COUNTY AUDITOR
Please do NOT send this form back with your tax payment to the county treasurer.
n.i��K�V
a I First Middle Last
BRYAN 1'4UL To48ERT
Mailing Address(number and street city,state,and ZIP code) lE1 Same as property address
sz yq /07.5
Spouse First Middle Last
I/v‘; c e F oAEeRr
Mailing Address(Number and street.city,state,and ZIP code) Same as property address
5a ? `' E /075Ai
. 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
?
-mouse a urre Date Telephone
PART 4:ADDITIONAL INFORMATION •