Homestead_Payne STN[FIRM StWJL l."10 IRIASuR[A FOAM tS'IA
.PPtOVED BY THE BOAREIOF entweirsieho MSC rlaED nl'Tit otewitIMLT OftOCLL COVER.%t4At•L'v.ct If t-tdr-*.l
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 ices-mike than cser for homestead fraud.Homestead fraud causes higher lax bills for all:therefore.
BEA 1343'-0114 requires tasparers who receive the homestead standard deduction to tetify that they are eligible to receive the
1® ' T1 benefit and m pt[aidc additional idcmifying information necessary to allow county govcmment w better m nitor homestead
filings.This information will be kept confidential and can ooh"b nraed by au ho zed county officials.The Depanmcm of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
. PART I: PROPERTY INFORMATION
_ APR 12 2012 Taxpayer Name Location Address
C r Payne, James M
1010 S LINCOLN ST
GIBSON COUNTY AUDITOR FORT BRANCH IN 47648
2552
James M Payne 1110101ii Ili 11 111111 111111011 IIJil 11111111D..11I111011111110101101110111 11
1010 S Lincoln
FORT BRANCH IN 47648-1724
II' '�IIIIIIIIII'I��"'I' ' 'I"il��l '��'�' "III����III'���I State Parcel Number Legal Description
I
26-19-19-103-000.301-026 LOWES ADD 42/43PT
-
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
r I First Middle - Last
JABS /1/, chze/ /7jey,)e-
Mailing Address(number and street,city,stare.and ZIP code) Same as property address
/o) ° Sr 4:-/.1 (o/i1 57 .
Spouse First Middle��, j Last
Mailing Address(Number and street,city,state,and ZIP code) F7�Same as property address
Social Security Number(last S digits) Drivers License/State ID Number (las:5 digis) Other(please specify in Pan 4 below)
I I I I stye
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
- "
�, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
State Form Sa73 (Rfi / 4-03)
Prescribed by the Departmenl o( Local Govemment Finance
INSTRUCTlONS: See reverse side lor /iling insfniuions.
��%/
I,,,� � FORM VEAR
yy� � HC70 �
� �
I(We) V Q 1Y� p S 1– c1 �� Il `P certify that�n t�'14t �y.d A�yy/20—
I(VJe) occupied as our principal place oi residence lhe following described real property for which a Homestead Prop�rjyN O redit is hereby daimed:
�I (VJe) owned ❑ Are buying under wntract
�� 3 2005
�Have a benefidal interest in lhe entity that is liable for the property taxes on Ihe property and that owns ihe pro�r is buying under a contraU.
If buying on contrad. Fee Simple owners name
olfice where contrad i5 recorded
County
Tavnship
Parcel number Le9al descriplion 1, a
� '1
011-GU3o►-oo i.rc.�e�/��
If any portion ol lhe rasitlential sWCtura a the land nd axceeding one (1) aae that imm�
o11he property utilized to produce income.
Record number
tawnsAip)
Page
Is the property in question:
- �+e� w�vanv o rnoeae Hw,�o u.c s,.,.n
�unds ihat swaure is used lo produce inoome, descnba the use and poNon
7`3>;`�r�,'t-_ ��r���iY':.�r�'-.�l+i�',:,`_. E:., PROP.ERTY;OWIJEU'�-Bl(_CLAIMANT�IIJ.OTFIER�COUNTIES:`�',,,'r.'_�'°�'�,`'��'�,` �"�+" �- a��r�,`te''K'�+?s "_��
County Ta.vnship County To.vnship
I hereby certify lhe above statements are We, corred and complete. Signat e ot claimant
�
�'ress (number aM stree; crty, stafe, ZlP code)
20 _ Pay 20 _
Lesser of 1/2 Homestead
vaivauon w E35.W0
3
Signature otAudRw ' � Dale signed