Homestead_Hart STATE FORM 51509(Rlrb10) IXEASLIEFR FORM TS A
APPROVED BY STATE BOARD Of ACCOUNTS,2009 PRESCRIBE]]BY THE DEP.ARIME■E OF LOCAL GOVERNMENT FPoAMCE IC 6-1.1.222.1
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 134--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
g I.acal Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
1tle PART 1:.PROPERTY-INFORMATION
Taxpayer Name Location Address
APR 6 2011 • Hart, James D .
C.�.nw°" v. --- 507 S Eastview
�c \ Fort Branch IN47648
2573 GIBSON COUNTY AUDITOR
James D Hart II_IhiI1�1111 III III hi I 1011111 iii Iii hi hlfl ii-_ii iiihit I I hi I UBIUill hill. II
507 S Eastview -Fort Branch IN 47648-1605
IF IIrIIIIItFIIFIII'll"��"Illlllll'll'IIlIllill'IIllll'llIllll'I State Parcel Number Legal Description
26-19-19-102-000.829-026/CLAR-ENCE TERRACE A 4
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- ' . -
O. . I First 'Middle • - Last
-) AMPS Oq7 E f/A2i •
Mailing Address(number and street,city,state,and ZIP code) ame as property address 57)-1 S -EA ss('rew FT, &t4"CH' 2"vCD )41'A 41c043 .
-
Spouse First 11 Middle Last
_ C.'_`( t n rl c r}
Mailing Address(Number and street,city,state:and ZIP Cale) n • _ • — -- - "'CITE.Sarre a-pnipeny address-- __--_____._-..,-. - -.-
50-t S C as+V1ew Sf. R-bran ih -rK) - /co48 •
-
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
� s..>F
�� °`
A '
�e�.
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (Fi2 / 5-92) .
INSTRUCTIONS: See reverse side !oi Iiling instructions.
FORM
HC10
YEAR
r CERTIFI ATION STATEMENT
I(We) � certify [hat on M 1
I(We) upied ur principal place of residence th ollowing described real property for which a Homestead Property T r i ere i d
I(We) owned ❑ Are buying under contract. -"'"`'f '� �
❑ Have a beneficial inierest in ihe entiry that is liable for the property taxes on the property and that owns the property or is 6� u�:f� 2A'ant;ect.
LUUU
CONTRACT RECORDED
If buying on contraa, Fee Simple ownets name
4f890N U Y AUDROR
Recardefs oKce where contract is recortletl Hecord number Paqe
a•
PROPERTY DESCRIPTI N
Counry � Tovmship Ta�dng tli �c (ciry, fo , fownship)
�
a I mbero — LeQrF'dascriPiion .
��
If arty �on of the residentla sWC[ure or Ihe land rrot exceetling one (t) acre Ihat irtunedatety surtounds that sWCture is usetl to D��� �me, tleunbe Ne use arW portion of
ihe pmperty utilizetl ta produce income.
PROPERTY OWNED-BY CIAIMANT IN OTHER COUNTRIES
Counry Tovmship Couniy Township
Si ure of claimant
�reby certity the above statements are true, correct and complete.
Adtlress (number and sfreeG ciry, slate, ZIP cade) �
� O nC.l�i �N
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAI
. VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (��
surrounding resideniial improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvemen[s
Garage (5)
Oiher improvements (6)
Tota� improvements (line 4 through line 6J (7)
Total value (line 3 plus line 7) (8) �
I hereby certify the above is We, Conect, and � Sgnature oi Assesor Date signed I
complete.
Verifying ac6on - Si9�mre of Auditor Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _ .
Lesser of 1/2 Homestead S �
Valuation 52,000
SignaWreolAuditor D � i n
I O' O