Homestead_Simmons _ STATE FORM 53500(R3/S-lot TEEASURFR FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.YW PRESCRIBE)BY THE BFPARTN.ENT OF LOCALGO ERNMENTHNAWE IC61.1-Eld.l
Gibson County Auditor IMPORTANT NOTICE TO HOIVIESTEAI) 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 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
T T T benefit and to provide additional identifying confidential inal and ion necessary my be to allow county government to better monitor homestead
lrul ,emu'./. .BrL//s 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: PROPERTY INFORMATION
•APR 1,3 2011 Taxpayer Name Location Address
Simmons, Donald
sC.9.tYb y
v �V\
?05 S McCrary ST
GIASON COUNTY AUDITOR Fort Branch IN 47648
7034
Donald Simmons - II 111111[III[II I�.III [IIImR1111111_II11II1II_II11IIIilIIDII1111I[II011110111_II
205 S McCreary
FORT BRANCH IN 47648-1317
Illtliltrltl6lLl"11111'I'II'I'I'I'tl'llllrl�lrlldrlltJrttl -- . State Parcel Number Legal Description
26-18-13-404-000.534-02VMCCRARY ETAL 66 PT
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.
,-w ._J''ART.2: TAXPAYER INFORMATION _ _
Ow.._. 1 , First Middle - ' Last
po.�� a T J 9 le , i- Jr)on5
Mailing Address(number and street,city.state,and ZIP code) -Same as property address
Spouse First Middle - Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
s l I I I State
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
ai.=''
� ; CLAIM FOR HOMESTEAD PROPERTY TAX
a��: CREDIT/STANDARD DEDUCTION
���'� State Porm 5»73 (R2 / 5-92)
%ai.
INSTRUCTIONS: See reverse side /or /ilrng instructions.
I - �. � � rccTmireTi
STATEMENT , "
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;- , ; : . ii�_�
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,'/u�' � "aI�'�r%!�
'e) ��� ��� JW�S�-�71%�_� ify ihat on the 1 st day of March. 19 /�
e) occupied as our principal p�ace of residence Ihe tollowing described real property tor which a Homestead Property Tax Credii is hereby Gaimed:
I(We) owned ❑ Are buyinq under coniract - � .
Have a beneficial inierest in the entiry ihat is liable for ihe property taues on ihe property and that owns ihe property or is buying under a contract.
CONTRACTRECORDED.
It buying on contract, Fee Simple owner's name , - � � .
Recordets ottice where contract is recorded Record number Page
PROPERTY DESCRIPTION
Couniy Township � Tazing distri
Parc number Legal e riptionC
01 i -O 3`f-�b
If any portion of the resitlential s;ructure or the land not exceetling one (1) acre
of t�e propeny utilized to produce income.
5urrounds that
� PROPERTY OWNED BV CIAIMANT IN
Township Counry
-__
certify me aoove siatements are true, correct and complete. �9 _ ure�
'number and street, ciry, state, 71P code) _.., n ��I , ,�
is used to produce income, descnbe ihe use a� portion
TownSh�
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL.
VALUE � VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatety .
surrounding residential improvements. (�) � �
Otherland (p)
Total land (line 1 plus line Z� (3� 1
Dwelling (4)
Residential improvements .
Garage (g) -
Other improvemenis (6)
Total improvements (line 4 through line � (7)
Total value (line 3 p6s line 7� (g)
I hereby Certify lhe above i5 INe, corrett, and Signature of Assessor Date signetl
complete.
�ying action - Signature of Auditor Date signetl
19_Pay19_
Lesser of 1/2 Homestead
DEDUCTION ALLOWANCE
5
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