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Home My WebLink AboutHomestead_CollinsCERTIFICATION STATEMENT MAY 10 I (We) _ l.ek" AR r ? t certify that on the t da o 1_s (We) occupied as our principal place of residence tthhe, following described real property (AUDhTORa Viomestead Property Tax Credit is hereby claimed: (1: I (we) owned ❑ Are buying under contract El property a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying it under a contract. CONTRACT RECORDED If buying on contract. Fee Simple Owner's Name Recorder's office where contract is recorded Record Number, Page' PROPERTY DESCRIPTION County Township Taxing Distri t ( i�; w , to nship) Parcel Number Legal Description kyc7G/ A o -00 at - lot - r - lo G If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc- ture is used to produce income describe the use and portion of the property utilized to produce income. ate- /a /- 00. /ro P -')/P PROPERTY OWNED.BY CLAIMANT IN OTHER COUNTIES ASSESSOR USE ONLY - TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON -RESIDENTIAL VALUE Land not exceeding 1 (one) acre immediately surrounding residential improvements Otherland Total land - line (1) plus line (2) Residential improvements Dwelling Garage Other improvements Total improvements - line (4) through line (6) Total value - line (3) plus line (7) (1) 1991 Pay 1992 Lesser of 1/2 Homestead Valuation or $1,500 19 —Pay 19 — Lesser of 1/2 Homestead Valuation or $1,500 CLAIM FOR HOMESTEAD PROPERTY TAX FORM vEAR (3) CREDIT /STANDARD DEDUCTION (4)- State Form 5473 (R2/1 -90)� (5) ° INSTRUCTIONS: See reverse side for tiling instructions." (6) CERTIFICATION STATEMENT MAY 10 I (We) _ l.ek" AR r ? t certify that on the t da o 1_s (We) occupied as our principal place of residence tthhe, following described real property (AUDhTORa Viomestead Property Tax Credit is hereby claimed: (1: I (we) owned ❑ Are buying under contract El property a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying it under a contract. CONTRACT RECORDED If buying on contract. Fee Simple Owner's Name Recorder's office where contract is recorded Record Number, Page' PROPERTY DESCRIPTION County Township Taxing Distri t ( i�; w , to nship) Parcel Number Legal Description kyc7G/ A o -00 at - lot - r - lo G If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc- ture is used to produce income describe the use and portion of the property utilized to produce income. ate- /a /- 00. /ro P -')/P PROPERTY OWNED.BY CLAIMANT IN OTHER COUNTIES ASSESSOR USE ONLY - TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON -RESIDENTIAL VALUE Land not exceeding 1 (one) acre immediately surrounding residential improvements Otherland Total land - line (1) plus line (2) Residential improvements Dwelling Garage Other improvements Total improvements - line (4) through line (6) Total value - line (3) plus line (7) (1) 1991 Pay 1992 Lesser of 1/2 Homestead Valuation or $1,500 19 —Pay 19 — Lesser of 1/2 Homestead Valuation or $1,500 (2) Signature of Auditor �. (3) Date Signed 5-/0-9/ (4)- (5) (6) (7) (8) 1 hereby certify the above is true. correct, and complete Signature of Assesor Date Signed Verifying Action - Signature of Auditor Date Signed STANDARD DEDUCTION ALLOWANCE ll� 1989 Pay 1990 �esser of 1/2 Homestead Valuation or $2,500 1990 Pay 1991 Lesser of 1/2 Homestead Valuation or $2,000 1991 Pay 1992 Lesser of 1/2 Homestead Valuation or $1,500 19 —Pay 19 — Lesser of 1/2 Homestead Valuation or $1,500 Signature of Auditor �. Date Signed 5-/0-9/ U A STATE FORM 535641,3/8.to) TREASURER FORMTS-IA APPROVED BY STATE BOARD OF ACCOUNTS.2039 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC 6-1.1-124.1 Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS 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,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 arc eligible to receive the FILED benefit and to provide additional identifying information necessary 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 Department of Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud. PART 1:PROPERTY INFOR\IATION - APR 1 2 2011 Taxpayer-Name Location Address - Collins, Hazel Life Est C. . 1772E GIRO RD GIBSON COUNTY AUDITOR . ' , HAZLETON IN 47640 17 Hazel Collins Life Est 11111 1111111111 11111 II 11111 111 11 11 11 11101111.111011 .1111111001111 1111111011 1772E Giro Rd Hazleton IN 47640-9375 ' IIIIIIIIIIIIIIIIIIIIIIIIllIltIulIIIIIIIIIIIIIIIIIIIIIIIIIII'tlilI State Parcel Number Legal'Description 26-02-48-101-000.169-018/LOC1011-104.71 AC PT . ✓ FRACT 28-1-10.10 AC PT LOC 2 FR -- - --- -- - .. -- - — 21=1=10.15AC-- ° / 'r • 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 INFORiIA1'ION Ov..._r I First Middle Last 494e. e CO tL.Z.A, s Mailing Address(number and street,city,state,and ZIP code) ❑ Same as property address 1 -772 6Z8U Ra - Spouse First Middle Last ` • Mailing Address(Number and street,city,state,and ZIP code) -" - - "'-D.Saine`ns pioperty"addreas ,. _ -- --^-' "— Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below). 1 1 1 1 1 1 1 1 I state 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