Homestead_Houchins STATE FORM 51569(0/&1% IREASU fl FORMTStA
APPROVED BY STATE BOARD OF COUNTS.MCA PRESCRIBID BY THE DEPARTMEST OF LOCAL GOVERNMENT FINANCE IC 61.1.34.1
Gibson County Auditor . IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and maried.cuuples 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 taxp(ers who receive the homestead standard deduction to verify that they are eligible to receive the
L./�' benefit and to provide additional`iAaldf ing information necessary to allow county government to better monism homestead
(� FILED 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
•
— • MAY 4 2011 Taxpayer Name Location Address
Houchins, Elgin R/Michelle D
6931'E 150 S
GIBSON COUNTY AUDITOR FRANCISCO IN 47649
1503. -
Elgin R/Michelle D Hou hies . ii I 111 flu till-f llItilIllliII II]11 111111111111 fill II iillIIlII011u]i1 I II II
6931E 150 S
Francisco IN 47649-9035
IIlIIIIIIIIIIIIIIIIIIIIrllltl IIIIIIIIIIIIIIIIIillllllIIIilll State Parcel Number Legal Description
—_ — - 26-13-20-100-001.440-004 /PT NE NW 20 2 9 1.00 AC - ---
•
•
This fclrm 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 • .
C . t First Middle
Last
F/51 d 40 tic h. )1. s
Mailing
(number and street,city,state,and ZIP code) I� Tu as property -
61g3 / , /50 S Franc, sco e17 ki g71_9
-
Spotue First--- t� /_ Middle - . Last
•
• Mailing Adaress�halmlber and street,city,sttate,and1ZlP code) - - —n",Samtras property address - - —
: ,
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.
Ow 4it ign - j c Date
.
t s*ai
CLAIM FOR HOMESTEAD PROPERTY TAX, FORM YEAR
1� CREDIT /STANDARD DEDUCTION.
State Form 5473 (R2 15-92)
INSTRUCTIONS: See reverse side for filing instructions. FEB 1 1997 -
-" CERTIFICATION STATEMENT JJ -
_I (we) _r_L certify *tt n t occupied a r principal place of residence the following described real property for which a Homestead '11;?' eF kerg4ptR�Rle
531 (we) owned ❑ Are buying under contract - - -
❑ 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.
.CONTRACT RECORDED .r
It buying on contract. Fee Simple owners name
Recorder's office where contract is recorded Record number Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - -
PROPERTY DESCRIPTION.
Court
Township
Township
Taxi g "strict (ci , town, towns
CC
a
Address (number and street, city, state, ZIP code)
Signature of Auditor
Other land
(2)
number
Legal descrip
Total land (line I plus line 2))
//P''arc���el
L3.1
Residential improvements
Dwelling
If 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 produces income.
-
Garage
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - -
County
Township
County
Township
#eby certify the above statements are true, correct and complete.
SignatVrq
of claimant
Address (number and street, city, state, ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Auditor
Other land
(2)
Total land (line I plus line 2))
(3)
Residential improvements
Dwelling
(4)
-
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pUs line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
_Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
S
Valuation or $2,000
Signature of Auditor
Date signed
it