Homestead_ReynoldsCLAIM 'TOR HOMESTEAD PROPERTY TAX
W* CREDIT /STANDARD DEDUCTION
State Form 5473 (R6 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
YEAR
FORM ITn
HC10
-I
CERTIF ON STATEMEN
�CPV�^: :�'4!�:
QOWVk��certify that on the 1st day of March 2
1 (We) occupied aKur l6rincipal place of residence the Following described re roperty for which at Homestead Property Tax: Credit is hereby 'd OJ-UN -1 4 2005
Q I (We) owned ❑ Are buying under contract aimed:
ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying undAr. a con ntray,-7
ICONTRACTRECORDED-
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
PROPERTYDESCRIRTION'
County
Trwnxhip
Taxing district
vsh:i�
I hereby certify the above statements are true, correct and complete.
PV[Lr-r Q0kQ6-M
Legal description
Is the propj
DQ.read
In quesTan:
property ❑ Mobile Home (/.C. 6-1.1-7)
If any portion of the residential structure or the land not exceeding one (1) acre Nat irtunadiatety surrounds Nat fifin,aura
of the property utilized to produce income.
i used to produce income, describe the use and portion
o P E k Tx o WN E 6, Ei Y. c Lai m WN T I Wo TH E lift 0 U N T1 E
41-tr
TRUE TAW
County
P;HOMESTEADR.1
Toomship
I hereby certify the above statements are true, correct and complete.
Signattire, of Ailment
0,ar(nu stniel city; state, ZIP l 1*J Whdyu U-
ASSESSOR
41-tr
TRUE TAW
ASSESSED VALUE
P;HOMESTEADR.1
NONIRESIDENTIIAL�.
Lesser of 112 Homestead
t�?;
rl��44 -_�K VALUE
Signatu i
_!A
_j
,Land not exceeding 1 (one) acre immediately
-N
surrounding residential improvements.
Other land
(2)
Total land (fine I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
(5)
Otter improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Data signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALCOWANCE
20_Pay2O_
Lesser of 112 Homestead
Valuation or 535,000 S
S
Signatu i
itor I
Date
%__ -1 -
------------------
STATE FORM!515IR:I■wI IIFAmaCR PoB.4 i}IA
APPROVED BY STATE BQARDOF ACCOUNTS.ym PP/SCRIBED BY TIE DEPARTHE2T OF LIXTLWSTbIMENT FINANCE IC 6-1.I-2:4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
• PRINCETON IN 47670 Individuals and married couples arc limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.;here is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-31100 requires taxpayers who receive the homestead standard deduction to verify that;hey are eligible to creche the
'S{ t benefit and to onnai c additional ept c iyine information necessary to allow county government to better monitor homestead
1 i >
j fi1inp.This inf rmation will he kept confidential and can only be accessed by authorized county officials.The Department of
Local Goverment Finance will use this information to create tools that will help county officials eliminate homestead fraud.
' PART 1: PROPERTY INFORMATION
— MAY 6 2010 Taxpayer Name Property Address
[�� Reynolds, Lance A/Lisa A
2 .
`7/p rQzl"'/. 6,z5 Hudson RD
•
172 GIBSON COUNTY AUDITOR PATOKA IN 47666
Lance A Reynolds
R1 BOX 12 B 1 o 2U J -p.ad'en Rd._ State Parcel Number Le;;al Description
PATOKA IN 47666-9080
iiiiiiiiii11IIIrrllrrtlllrltlllllrltlltlrll ilikurll1111 26-04-26-400-000.606-020 018-00606-00 PT SE 261117.157 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
Owner I First Middle Last
LANCE A RE Yn(o 1-u s
g Address(number and street,city,state,and ZIP code) Ilome as property address
LORD S.- /Iuosoi Rd Pajoha /N 1176610
Spouse First Middle Last
L15it A IE{(r(oL.DS
Mailing Address(Number and street,city,state,and ZIP code) t me as property address
SAME AS ABovE �_rI -
1 PART 3:CERTIFICATION. -- .— - -- . -- --
Each undersigned certifies,under penalty of perjury.that the above and foregoing information is tae 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 Signator / Date