Homestead_Coburn STATE FORM 5569 0U1 RIM TRFASURFA FOILM TS-IA
APPROVED aI"STATE BOARD Or ACCOUNTS.]tM PRESCRIBED aYTIIF.OFPAPIME\i OF IfMA1.CANiRSMEYr FlYAV(£If.bl.l-IIJ.I
- 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 muses higher lax bills for all;therefore,
�` T HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
0 FILED` benefit and to provide additional identifying information necessary to allow county government e to better monitor homestead
■•Lp■ 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 1: PROPERTY INFORMATION .
APR 13 2011 Taxpayer Name Location Address
C Coburn, Steven M/Nicole R•
2582 S 650 E
GIBSON COUNTY AUD TOR FRANCISCO IN 47649
1573
Steven MCoburn
III�IILflIIILIII DIII II1IDfill�1�11_II dll�ll.11 111I�IIII�II�011011_II IIIII
2582 S 650 E
Francisco IN 47649-9201
IIIIl'ulllIll'III'II'ICI'IIlIIII1'I"I1l1llll'lll'll"Illllltllt State Parcel Number Legal Description
26-13-29-100-000.430-004 PT NW 29 2 9 4.00 AC
-- - - - -
3
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?:TAXPAYER INFORMATION
Ow , First Middle Last
Steven MIC-‘045...8._\ Cc ou cn
Mailing Address(number and street,city,state,and ZIP code) III--Same as property address
aSSa S 450 E, c e -o t s_t `kn oy9 ,
Spouse First Middle Last
n i CO 1 E -- ewe e_ e.COOU-In
— Mailing Address(Nuthber ndd'strcet,City;state;and"ZIP code) - _ _. - 1-j3amcas propertyaddress . __
a5%a S tDSC E, Fe_o._\c.(sc.c Lt-k R'�tong u
- - . . -
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 Sign Date
CLAIM FOR HOMESTEAD PROPERTY TAX
a� CREDIT /STANDARD DEDUCTION
State Form 5473 (R215-92)
INSTRUCTIONS: See reverse side {UprU((ling instructions.
Y
`.'. \•,- r—�•CERTIFICATI
FORM YEAR
HC10
'(W
e) certify that on the t st day of March, 19_
�We) occu as our principal plac(�jol r(es�idence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
(We) owned ❑ Are buys er nt act
LJ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
_ CONTRACTRECORDED
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
,.'
County Township I County Township
PROPERTY DESCRI N_g ` -_-
r
County
Township
2.Y!! sca t U 7G yr'
Taxi diatri (city, town, ship)
,f Pa 6N,f( —r o oo.
x at description
ASSESSED
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
° PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County Township I County Township
ereby certify the above statements are true, correct and complete. Signatu,
Lesser of 1/2 Homestead
.dress (number and street. ary state, ZlP mde)
2.Y!! sca t U 7G yr'
S
`,
TRUE TAX
ASSESSED
HOMESTEAD
NON- RESIDENTIAL,'
ASSESSOR USE ONLY
VALUE
VALUE
VALUE .-
VALUE --
Land not exceeding 1 (one) acre immediately
_
surrounding residential improvements.
(1)
eQ.
Other land
(2)
'
Total land (line 1 plus line 7)
(3)
Dwelling
(4)
Residential improvements
- F.
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby Certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
' - STANDARD DEDUCTION ALLOWANCE'
19 _Pay 19_
Lesser of 1/2 Homestead
S
Valuation r 52,000
Signature of Auditor
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