Homestead_White (2)1
CLAIM FOR HOMESTEAD PROPERTY TAX FORM R
CREDIT /STANDARD DEDUCTION M �I� (1
Sate Fortn 5473 (118 17.07) HC 1 ZO 9
,. Prescribed by the Department of Local Government Finance d
INSTRUCTIONS: See reverse aide for fifirg instructions.
I (We) azc' C -� '.I� / r- eA� OJ/v & certify that on the 1 st day of March, 20_
I (We) occupied as our principal pi V, of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACTRECORDED
If buying on wntracL Fee Simple owner's name
Recorders offioe where conVact is recorded Record number Page
County
Tavnship
PROPERTY r
Taring (city, to , township)
Parcel number
Legal description
I Is the property in question:
or 43,000 for 2009 pay 2010 40,000 payable after 2012
AT. 100% OF TTV
}
37/.78 S3 ❑Real property ❑Mob le Home (/C 1.1 -7)
If any portion of the residential structure or the land not exceeding on
(1) acre that immediately surrounds that structure is used to produce Income, describe the use and portion
of the property utilized to produce income.
300 -o00.
�FO9- 0a0
County
Township
I hereby certify the above statements are true, correct and complete.
(number and gwL city . state: and
•• USE ONLY
TRUE TAX VALUE
•
HOMESTEAD
NON-RESIDENTIAL
$
or 43,000 for 2009 pay 2010 40,000 payable after 2012
AT. 100% OF TTV
VALUE
VALUE
Land not exceeding 1 (one) acre immediately,
surrounding residential improvements.
Other land
(2)
4
Trial land (lime 1 plus lime 2)
(3)
� hsi
Dwelling
(4)
� f,'n`
Residential improvements or Annually
_ 1v •e..zti
Assessed Mobile l Manufactured Home
Garage
(5)T,.:
�,s�.. R �,�
y -
Other improvements
(6)
Tda1 improvements (Me 4 through firle 6)
(7)
Trial value (line 3 plus tine 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (madh, day year)
STANDARD
20 _ pay 20 _ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser 44,000 for 2008 pay 2009 41,000 for.2011 pay 2012
Homestead Valuation
$
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor
to signed (momh, day, year)
SLATE FORM!:• grn.o, MASUU S FORM 11A
.APFMxED BY STATE BOSPOOFACY)11.ars 2r r PRESCRIBE/38Y n1E DEPAaT NT("LOLAL GOVERNMENT FINANCE e41.1-r-tr
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
more 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 seethe the
®
F 1 benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
(Iglu' I, filings.This information will he Lela confidential and on only be accessed by authorized county officials.The Department of
t Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY LNFORMAT1ON
APR 2 2 ZU10 Taxpayer Name Property Address
`-��� //�/ White, Dale Ray/Tina Nichole
7�f /J PO 13ox_
GIBSON COUNTY AUDITOR Patoka IN 47666
29 3o 2- SPr;n5 St .
Dale Ray White A'fo LA- I N
PAP 0 Box 194
OKA IN 47666-0194 State Parcel Number Legal Description
Mull Il 111.1..111..111..11.. 'III I III I I I II 26-04-24-300-000.409-020 018-00409-00 WOODS ENLG 37/38/53154
1 11 1 111 11 1 111 .. r n
K
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
Dale "Ray Wh�1-c
Ong Address(number and street.city,state,and ZIP code) Same as property address
P o Boy Iq la+-ka IN /471.0[
a
Spouse First Middle Last
Tina TWCOIe Wh� �
Mailing Address(Number and street,city.state,and ZIP code) n Same as property address
Imo Sox. I(I Lf 1)afoka T H7(oo
CERTIFICATION
— — Each undersigned certifies,under-penalty.ofperjury..that.the.ahove.and foregoing.informationfs.rrue.and correct and.that he.or.she.is elieible.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
PART 4:ADDITIONAL INFORMATION