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STATE FORM 51540(0.3 b10) , TREASURER FORM TSIA
. APPROVED ST STATE ROAM OF ACCOUNTS.AN PRESCRIBED BY 11W DEPARTMENT OF UCALGOTT'ER.\'MEYT FLNANCE IC 64.1.22.2.1
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 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 to better monitor homestead
filings.This information will be kept pt 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 10 2011 Taxpayer Name Location Address
C,�•fr Overline, Ray/Alena
10282 S PHEASANT RUN
—
GIBSON COUNTY AUDITOR HAUSSTADT IN 47639
2308 ..
Ray O erlime 1110101II-01110111101IIIIJ1.IIIII 0II IIDDIIDIIZII-I IIDII010II_I11111II-I0101IIIII
10282 PHEASANT RUN
HAUBSTADT IN 47639-8620
IIII111LllllrLI1III1I'II"ll'Illllll'llllll'I'I'lll' 'llill"I State Parcel Number Legal Description
26-18-36-300-002.104-02y HUNTERS CROSSING 2 LOT 15
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
•,- .. 1 First - Middle - Last
�Ay EAWf\ RJ OYE(LaNE
Mailin Address(Bran d s rote, ZIP c e) - Same as property address ,
).(74%„S� ►� 9
-
Spouse First - - Middle Last
bECEASEI .
Mailing Adders and street,city,state.and'ZIP code) __- '-— e DSame as property address-r ^-- —_-,.- ,s-.-
0
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) - Other(please specify in Part 4 below)
, I I I I I I I I I Stn
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.
Owne nature Date
•
�, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
j Siate Form 5473 (R6 / 4-03)
PreStribed by lhe Departmenl o( Local GovemmeN Finanu=
INSTRUCTIONS: See ievcrse sidc (oi Iiling insfruclions.
FORM
HC10
, �,�,/ �
YEAR
I (VJe) /\ 9� �
certify that on�the 7st day of March. 20
I e)� occu ied as our rin �
�(W,/ p p place of residence Ihe following described real property for which a Homestead PropeAy'7ac Credit is hereby daimed:
IX I(We) owned ❑ Ne b n under contract �—` '- -'!'" ��'" T�M� v
�M 9 3:BSOn CCJ�� � >UDITOR �
` Have a benefidal interest in the entiry that is liable far ihe property taxes on the pmperty and that owns the pmperty or is buying under a wntraG.
I( buying on coniraq, Fee Simple ownefs name
Recordefs offica whera wnUaIX is
a--,•��p,:f�J ..�,
:-r_ xw.. _lt:e-l3�t#.�.��
County
Parcel number
Township
Legal description
v v-y-v � io�r- i �.,r �L A,,,,.
H any porlion of Ne residential sUUCture w the land not ex ing�1) aae tha[
of Iha properry ulilized to produce inwme. �S
— i o —.'v,. _ _-i ut � —
RecorA num6er
(ciN. tayp. fownshiP)
Page
I Is'he Propertyjr(QUeslion:
�LJ Real pmperty ❑ Mobile Homo Q.C. biJ-�
sunounds ihat sWCtura is used lo produca income. describe Ne use and portbn
2fQ( Pay 2�
Lesser of tl2 Homestead
vauanon w 535.000
�r
5
signed