Homestead_Middleton MMAlE FORM,)K IC.P“NI IREASUAER FORM i$IA
.ArPrI ED BY RAIL BMRD(WACCOUNTS.9n, PALYAIBW BY T11r DEPARTMENT Of LOCAL COER:Pah,FEAet'E Ie6-1.122.1
Gibson County Auditor
101 ��-Main
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sandard deduction.As the receipt of this deduction becomes
® more beneficial.there is more incentive than ever for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
HEA 1344-21709 requires taxpayers who receive the homestead standard deduction to ceril'v that they are eligible to recent the
benefit and to provide additional identifying information necessary to allow county government to better monitor homesteal
filing-.This information will he Lept confidential and can only be accessed by aW hnriied enmity 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
Taxpayer Name Property Address
Middleton, Jeffrey L/Tambra D t/
RI Box 259 cQ
Francisco IN 47649
4659
Jeffrey L/Tambra D Middleton
7890 E SR 64 State Parcel Number Leaal Description
Francisco IN 47649
26-13-21-100-001.088-004 002-01088-00 PT SE NW 212 9 2.3866 AC
XC1
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
JEFFREY LYNN MI17 � ETaAI
ling.Address(number and street.city,state,and ZIP code) —-— _. . -- -- — — Ef-Same as property Oddzts ' --"" - — — -
1 R 3 fr- 1 S I 0 -A--e- `RA-1.01P F RAN L' 1 s o Z x c 41 Co 14-`�
Spouse First Middle Last
T iJje:. RA -1) E74ISE MI7)-bLET(Al
Mailing Address(Number and street,city,state.and ZIP code) ate--same as property address
9ggo F . S t & Rol /f4 u .
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 deductionon 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 Sign tore / Date
a•- ^-•tea.
eE ,
CLAIM FOR HOMESTEAD PROPERTY TAX
County
CREDIT /STANDARD DEDUCTION
Taxing district (city, own, ownshi
State Form 5473 (R2 / 5 -92)
Legal tlescriplion
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
/e) "w_ / Yom- certify that on the 1 st day of March, 19
I (We) occupie as ou r cipal ac o residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑� 01 ed Are ng under contract d
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the ooper� ors .r er contract.
. .. CONTRACT RECORDED WAN 1 V. 1994
It buying on contract, Fee Simple owner's name
;d'. yY s
Recorder's office where contract is recorded R Page
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
L-inty
PROPERTY DESCRIPTION
County
Township
Taxing district (city, own, ownshi
?7M 1pombpr —O Q
Legal tlescriplion
(C.
� _
. 38
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 produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
L-inty
TRUE TAX
VALUE
Townshi
County
Townst ip
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
I hereby certify the above statements are true, correct and complete.
Signature of claimant
dress (number and street, city, stare. ZIP code) '
I
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
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 (fine 3 pl/s line 7)
(g)
I hereby certify the above is true, correct. and
plate.
Signature of Assessor
Date signed
Tnfying action - Signature of Auditor
Date signed
19_Pay 19_
Lesser of 1/2 Homestead
Valuation or $2.000
STANDARD DEDUCTION ALLOWANCE
$
t�