Mobile Home_Osborne ~ STATE FORM SIkN(0.l MICE TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ICCOUVTS.lmi PRESCRIBED Dv THE DFPARTMEAT OF LOCAL GOVTANMENT FINANCE IC 6-1.1-23-ti
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,
F T L E D HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
7 1 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.
APR 18 2011 PART I: PROPERTY INFORMATION
C .h Taxpayer Name Location Address
Osborne, Jacqueline/Donna Mays °
GIBSONCOUNTY AUDITOR • 303 W Vine
PATOKA IN 47666
' _' 11780 >II — IIII -- _ __
Jacqueline Osborne ilI�III_�II�III lull��ll�llll_IIIIII_II �Ilull_II�II
303 W Vine St .
PATOKA IN 47666 ,
State Parcel Number Legal Description
26-420-05006-00 1978 Walden -
t
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.
C _. I First �(� Middle Last
Ilk M-Bile A (number and street,city,state,and ZIP code) 2/Same as property address
c-C Ds. be ate, P. 0 /B A •..),"'Y7416
Social Security Number(last 5 digits) Driver's License/State ID Number'(last 5 digits) Other(please specify in Pan 4 below)
•
Last
a /Vie- tea,✓
Mailing Address(Number and s t,city,state,and ZIP code) 21Se=as property address
103 411/:e �., Rt P. o Ste 9s'yr 7tAr J ,ems-4‘7Z.2
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits)' Other(please specify in Part 4 below)
[ _
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.
I Signe Date
f
C
4
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R12 / 8-09)
'O Presaibed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for filing instructions. B _ r.A••/t
,' i . .! 1 —7
i )t ) ni;m
JUN 2 1 WU
CERTIFICATION STATEMENT
I (We) i/Yf. E rl/L/CCi -� 7��
certifylilt33 �si6dndpal
place sid or am (are) buying the following described (Veal property for which a Home ad Property Tax Standard Deduction is hereby claimed
under ntract on the date this application is filed, (date of filing):
❑ 1 (We) own ❑ Am (are) buying under recorded contract
QU �(Jflu (qL�7
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
. 1
❑ Have a beneficial interest in the trust or the tight to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of :roan (legal name)
K�
dv3s)
Dover's license / Identification /
Name imant'ss (I al name)
Soda] Sec#y number of imam's spouse ( five digits) D - fs Ixrnse I Idenfification I ONw number
Iswag to
/� /
CONTRACT RECORDED
If buying on contact, Fee Simple owner's name
Recorder's office where contract is recorded
Record number Page
PROPERTY DESCRIPTION
County
Township Taring di (city, town, t
n
cl/
Parcel number
Legal description
Is the
Fi question:
Real property ❑ Annually assessed motile home (IC &1.1 -7)
IN OTHER COUNTIES
Cwnry I Township
County
Township
I hereby certify the above statements are true, correct and complete.
nature of daimant
'e"
Address (umber and seet, cfysate, and L code)
w
•• • r till
• r • r
Land not exceeding 1 (one) acre immediately
-' :. ^i ` - �+'('iTS — "✓' . �x
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
g
( )
,?E''''" pr rr'TiF` =: v>
- ° YfY. r `1au
Residential improvements or Annually
Garage
(5)
Assessed Mobile I Manufactured Home
Other improvements
(8)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month' day, year)
and complete.
Verifying action - Sgnatum of Auditw
Date signed (month, day, year)
STANDARD r r
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or 545,000
Notwithstanding any otherpmvision, the win of the deductions pmvkW in IC 6-1.1 -12 to a molige home that is
5
not assessed as real property or to a manufactured home that is not assessed as real properly may not exceed
one -had (12) of me assessed value of the mWe home or manufactured home.
Signature of Auditor
Date signed (month, day, year)
OATh 10551!39M nt_r,t-N1 TREASURER FORM 79-IA
APPROVED BY MATE BoaPDOfAm(inrc!nn • Miff,tDS)BY THE DEPARTMENT OF LOCAL°WELMrNI FI:AwcE IC 11.1.1-L.11
Gibson County Auditor
101 N Main RIPORTANTI 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 acv for homestead fraud_Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-3009 requires taxpasers 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 he kept confidential and can only be accessed by authorbed county officials.The Depannum of
Local Government Finance will use this information to create togs that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Mays, Sammy R/ Donna F
302 Vine
Patoka IN 47666
510
Sammy R/Donna F Mays
P O Box 95 State Parcel Number Leea1 Description
Patoka IN 47666-0095
l,liill iiililluuil�tt illi ill iii��rlt liluiil ili luliit�t lutullt� 26-04-24-303-000.228-020 018-00228-00 COL DIV OUTLOT 8 PT
PART 2:TAXPAYER INFORMATION
Owner I Last
-_(,rnT First Middle s'('�°(\�
leg Ad (number and iuCt,Ely,state,la ZI code)— `r -__ __. — _ _-0 Same as orogen, address-- -- — - — - —-
3o3 de.").-4- s c e Qn 9S �P - 1f7G44
Spouse First Middle Last
Mst
Maililla Address(Number and street,city,state,and ZIP code) ❑ Same as properly
SD.3W.VV,�L Sr- P. v./hi 4o pst j„, 57446
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 I Signature Date
PART 4:ADDITIONAL INFORMATION