Homestead_Campbell (2) STATE FOAM EYt tp0./A+MI TWSSttUE HOLM:31A
APPROVED RA STATE BOARDED Ar\TP'.MS.DP. PEEV(TIPm BY n rr DEPAREAGAfCIF LOCAL C VELNMEAl FINANCE IC 11-1.1-U.1
Gibson County Auditor HOMESTEAD PROPERTY OWNERS _ n IMPORTANT NOTICE TO HO
101 N Main
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 incenthe than erer for homestead fraud.Homestead fraud causes higher tat bills for all:therefore.
• FIFA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to=the the
benefit and to provide additional identifying information necessary to allow county goverment 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 aids that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Campbell, Christine
_ 909 Blackfoot DR -
Fon Branch IN 47648
2794
Christine Campbell
909 Blackfoot Dr State Parcel Number Legal Description
FORT BRANCH IN 47648-9509
26-19-18-101-001.151-026 011-01151-00 LITTLE YORK PHASE 2 8
lu II ulIr I nuI n II nI tI l'lIa II nl I II n II utI t I uu I t I u I
/ D-27
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
-- - -- —16. 1=,k; — — - -- - .cA-M-,P.gc�- - - __ -
�ng Address(number and street.city.state,and ZIP code) dsame as property address
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
Stitt _
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.elaiming additionalhomestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Ow r I Signature /} Date
•
j5^��F O
;i =
. `;
r
'�i
1 16
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION =
State Fortn 5473 (F2 / 692)
INSTRUCTIONS: � See reverse side lor (iling instructions.
FORM
HC10
YEAR
�, • CERTIFICATION STATEMENT -�
d �1
I(VJe)� certiy that on the 1st�tlaynW Merch, 19_
I(VJe) occupied as our cipal place of residence e following described real property for which a Homesiead�P,ro�pe}ly�T9A Credit•is hereby claimed: .
❑ I(We) owned ❑ Are bu in under conirect r' '� Q
i
❑ Have a beneficial inierest in the eni ry that is liable for the property ta�ces on the property and that owns theproper�_o[,ls btiy��ing � er a cq{�tra�T
\U'� I I `
( L�
CONTRACT RECORDED ��i' : �;::`�"
11 buying on conVact Fee Simple ovmers name � Y�'.' ;
�.
- �; _o('��`.7-
Recortler's oHice where contract is recorded � � 7_ Recortl number . Paqe
1
PROPERTY DESCRIPTION
Coun r�_ Tovm;hiy � Tamg tlistri t"-ty/, rown, fowns pJ
yrir/ �i%V/ N�D�
Parcel number Legal tlescription
If any portion of the residen6al strucmre or Ne land noi exceetling one (1) acre that imm�atey surtounds that struaure is used to produce income, descriDe Ne use and portion ol
�h A�e�ly-GlizQQ t� � gq�t ir� rt�
/�1 � \ % � �L1/
t.� �
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Sign of laimant
iereby certify the above statements are true, correct and complete.
Address (numberaM sfreef, dry, slate, ZIP code) , '
o �Kr ov� -- v�,e.4�c�-E�
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding i(oneJ acre immediately (�� _
surrounding residential improvements. �
Oiherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Oiher improvements (6)
Total improvemenis (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Si9nacure oi auesor oaie signea
complete.
Verify'u�g acfion - Signature of Audiror Date signetl
. STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
esser of 1/2 Homestead S �
Ve tion or S2,000
/
Sig�ture of Audiror �/ Date signetl
� � �� ^ mC7