Homestead_Collins (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R2/ 5-92)
Ifi
INSTRUCTIONS., See reverse side for filing instructions.
CERTIFICATION STATEMENT r''?E 't{TY A;ii;ITOr:'i
1 (We) certify that on the 1st day of March, 1g_
(We) occupied as our principal plat of residence th Ilowing described omestead Property Tax Credit is hereby claimed:
`II
1 (We) owned E) 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.
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taxing dist' (city, own, to ships )
��J,_A,•`�R'
Parcel number
Legal description
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township County
Township
Sig re ofd t
.reby certify the above statements are true, correct and complete. /
Address (n be and street, city , state, ZIP code)
25 87666
i !m
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
Verifying action - Signature of Auditor Date signed
_® STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
5
Valuation or $2,000
Signature of Auditor
Date signed
�l
STATE FORM S3569 MAO)IB) MEr54RER PU0.1 TS-IA
D R STATE BY STATE BOARD OF ACCOUNTS3:09 PRESCRIBED BY TIM DFIARME\T OF LOCAL CAVFA\MEYF FINANCE IC 6-ILII21
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,
• I L E D HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
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 I: PROPROPERTY INFOR,MA PION
MAY 5 2011
Taxpayer Name Location Address
C.13.N Collins, Vaughn D/Pamela J
vv o
GIBSON COUNTY AUDITOR PATOKA IN 47666
1031
•VaughnD/1'et„elaJCollins 11111111111:1111111 11-8 I_IIniIfllBBill:Billii_ii:iUIIi]BI1111110Ol iiil011IHIII
5424 N 75 E
Patoka IN 47666-9164
1'1rtt11111111111'11111'1111"'1'1'11111111111111111'111'11111111 State Parcel Number Legal Description
26-05-58-026-002.299-018/ PT MD 25/26 1 10 44.00 AC
C-1-D-12
9
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.
_ f . PART 22 TAXPAYER INFORMATION _ _ __
" er l First Middle Last
Upuah A `) C6�.Lws
Mailing Address( and street,city,state,and ZIP code) Same as property address
S y2yg 7sE P1+-t0Kn rW 4/ 7666
Spouse I First Last
NA
�Ip
KA9 C0LLN5
Mailing Address(Number and street,city,state,and ZIP code) fyr Same as property address
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 tgnatlue Date
[ a'?"mGJr-� eGCP ' /N,[ j i�/ `e/1'7 el/Yea tan' CC-A.4' .