Homestead_SollidayCLAIM FOR HOMESTEAD PROPERTY TAX M 0 FORM
CREDIT /STANDARD DEDUCTION Hc�o
t State Forth 5473 (R5 / 10-01) '
`eu Prescribed by the Department of Local Government Finance
INRTRIICTI0NA- .Con mveRe eirin rn. Filfnn i-1-6—
-H—
YEAR
1 (We) v L (I / %' ' n the 1st day of M� 1c�t {i 20
I (We) occupied as our principal place of residence the following de bed real property forwhich a Homestea roperty Ts �red1 is h1101 daimed:
❑ I (We) owned ❑ Are buying under contrail - r
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buynglu.[ider a.co tract
- •- '#;e° �s =-uut , '"". L-"° '�1c C0NTRACT'REC0RDED . r „F S � # '`"mod .`i •Ft "r .
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
d- f�..7a`•$�.€ 0W—M
�i- +'�r�-
•-". '1 . — _ Z _. _ —'_ ._ __ _ _ -rte-t Tif e. uPi -
�k:;�- `tom. P,ROP,ERT;YrDESCRIP.TION`��ad ., �= c�. e ;�Y.�rir3�:�`��¢b�'r�..'r�'Y�' -•
Coon
Tomship
Taxing district , to ship
arcel number
rlasy� ory�
y , /
Is the pro in 9ues6on:
VALUE..
/1 /,W1 C1\/ (,�— / —/ f
� a
l \`+��1 Real property ❑ Mobile Home (LC. 61.1 -7) .
H any potion of the residential structure or the land not exceeding one (1) acre that ilnipediatety surrounds that structure is used to produce income, describe the use and porn
of the property utilized to produce income.
rl�l /r`•-�
C) C)D�l) -c�a
'
�s`. ,' �", �" F-°," ���. �, t. �sr�- .PROPERTY,OWNEDBY'CLAIA7ANT;IN; OTHER` COUNTIE §'.��fi���nt�°- i'.kfr'3mw.�1�"
County Township
County Toomship
hereby certify the above statements are true, correct and complete.
Signature of claimant Loa 1�n 11
ress (number aM street, city, state, ZIP code)
�.� I Sox 144 �•o.3ax 2q( �i a+n>`a z&) 4�v�b
ASSESSOR, USEONLY i }5''
UETgX>a4 •'
ASSESSED VALUE
'`AT100%'6E
HOldESTEAD
�'
NONWESIOEWMA " bLi
�..n "'
'
VALUE"
_.... z�. .._
��. l TY
VALUE..
•j LUE�'e`•*' -?
adL',5..,,...�.s.
Land not exceeding 1 (one) acre immediately
(1),«
�' " .-'�� ' r
surrounding residential improvements.
�„� .,,- - - „r...: _
Other land
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
r ,11
Residential improvements
Garage
6
, _
*�
-..,�_
()
v.
Other improvements
(6)
-„
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus 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
on S1r.� . .�M�-wm—m7 -r`,Wy STAN6ARU`. DEDUCTION "ALILOWANCE�t�r�.'3_��
20_Pay20_
Lesser of 1/2 Homestead
Valuation or $6,000 $
Sg fqudeor ate signed
�JD 1f
�� {{ tL-10 -
MATE FORM!y atR_/3W1 TREASURER FORM StA
APPROVED BY Oar:BOARD Of 4ACO NrS.2l$N PIF5rRJOm BY THE DEPARrsEvr(F LOCAL GOVERNMENT FINANCE tcFu.-_-..t
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
to. FILE is: mere beneficial.there is more incentive wh than ever for homestead fraud.d deduction fraud causes higher tax bills for all:therefore.
FILE HEA 1344-2009 requires taxpayers who receive the homestead standard dduction to verify that they are eligible to recebe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.Ibis 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.
APR 2 0 'a l° PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
77(0a 4, Solliday, William D/Mary Beth
GIBSON COUNTY AUDITOR Cross ST
Patoka IN 47666
23
William D Solliday
P O Box 291 State Parcel Number . Legal Description
PATOKA IN 47666-0291
IEIrtlltrtlElltttllrrrllrrll I IIII IIIEI 11111111 26-04-24-401-000.211-020 018-00211-00 PT W SE 24-1-11 .421 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
1,1/451 1 1.(+m U 2c� 1 So I (t d. -
4111g g Address(number and street,city,state,and ZIP code) [] Same as property address CJ
�o 36X 711 ' zy--Na crm
Spouse First Middle Last
M `?
Mailine Address(Number and street,city,state,and ZIP code) Same as property address V
? p & a�I I rP r_o-- _ks (O
PART 3:CERTIFICATION
—- Each-undersigned certifies;underpenalty-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
•