Homestead_Brown (3) STATE MVO!flea,M1:/ I TITANIA PORN—iA
APPROVED DT SIAM IPRSRDOv ArRt'.NTS.9x PIACILIDED BY TIM DEPARn tT OF LOCAL fA tNMrHT FINANCE MH.I-L-ti
Gibson Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
•
101 N Main ain
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than e'er for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
Mr HEr\ 1343-2009 requires taxpayen who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying informamon necessary to allow county government to better monitor homestead
filings.This information will be kept confidential and cm only be accessed by authorized county officials.The Depannient of
Local Government Finance will we this information to create tools that will help county officials eliminate homestead fraud.
_ PART I: PROPERTY INFORMATION: .
Taxpayer Name Property Address
Montz, Shawn Anne
R 2 13ox 155
Princeton IN 47670
1640
Shawn Anne Montz
3580 E SR 64 State Parcel Number Legal Description
PRINCETON IN 47670
26-12-23-100-001.513-004 PT NW 23 2 10.9052 AC D10
_. ._ _ _ _ __. _-- __
X—- — - _ _ _—_
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 1NFOR\1ATION .
Owner I c \,, First Middle Last
(S\ ckuin Anne f Y�n`0n-kZ
410,g Address(number and street.city,state,and ZIP code) 0.Same as property address
`ss�o L . SR toy _
Spouse First Middle Last
Mailing Address(Number and street city,state.and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
__
_ Sege ..
- 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 1 Signature Date
.
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YF�R
CREDIT/STANDARD DEDUCTION J�j� HC10
ti State Form 5473 (R71 S-W
P-escnbed by the Deprehnenl of Local Govenwwd Fiance
INSTRUCTIONS: Sae reverse side for filing instructions. FILED
.. COrMCATION STATEMENT -
I (We) l i /CC M (.tne,�.. / / _ �erbly that m theecIst Tay of fdaN, 20 -Tj 1 1 occupied as our principal place o: residence the following d ((�JJ mil proppr y far which a Homestead Pro PertYO' %a� itis by claimed:
owned ❑ Are burying under contract a fr�f1'I�,1
Have a beneficial interest in the entity Chat is liable for the property fazes o the property and that owns the potpBerlyO� rs wyumjY�rnPl'fracL
. .. • . --- •.• .; .- . CONTFACT- RECORDED•5' "..• - •... ". . , .. _ .
If buying on mmb Fee Simple owner's name
Pjmdees office where cummav is recorded Rend number Page
PROPERTY .DESCRIP'T10N: . .,. .. _. ,..
County
Towdup
TBCOV d' fwnsfda)
nship
I hereby certify Coe above statements are true. correct and cornplete.'`
Parcel mobs ..
le the pr°per question-
06 _ _l�A
9y
1 Aoty D Mobile Home (CC. 6f. / -7)
rc any portion of the o the lard nal exceeding one (1) ova that mnme3atey svrtaxiN tlat structure le used m produce income, desabe the use and portion
d to Prod me
dl[m//enyo`pner,(y omduca :none. {
,VALUE
/^ /wfrzadm
��
J
a6- 1a -a3 -ICO-COQ.
-PROPERTY owwEDerctAahAdi .eN OTHER couNrfes•.-
County
Township
County
nship
I hereby certify Coe above statements are true. correct and cornplete.'`
AT 700X
�hass (number and sbeeC o* stats. Z!P coda)_
r, Cj
..
. r : , .
- }S'k
.•. 'n
`:. TRUE�TA7L :
ASSESSm�VALUE
'.HOMESTEAD,
'. r, NOMESH)ENTIAL x ..�.
+r
"-ASSESSOR USE ONLY
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AT 700X
i.. ':`
VALUE
_.
,,,.VALUE
,VALUE
:.'s
Land not exceeding 1 (one) acre irmmediately
surrounding residential mnprovern tnta.
(f)
I. _ '. ,p• -.:. J r A
Q&m lard
(2)
.. '
4'Y
TcU land (Pure 1 phis roe 2)
(3)
Dwelling
(4)
Residential unprovements or Annually
Assessed Motile I Manufactured Horne
Garage
(5)
Other improvements
i
Trial cnprovemerds (tine 4 CrrvuWm Fria fi)
i71
Total value (Icre 3 phs Em 7)
1 (g)
I hereby certify the above is true, correct. and
complete.
I Signature of Assessor
Dare silned
Vedynrg an.4m - sigma" of Addy
I than %Yr—1
S'FANDARODMUCTMALLOWANCP - -- .__ _._ -` __ _
20 _ Pay 20 —
Lesser of 12 Horoest ad
Valuation or 535,000
5
Sigratme ofAudrmr to signed