Homestead_Moore A start FORM!!'MIR_/' 1 MEASURER FORM TIA
ArrRrwEs BY STATE WARDEN'y7R\ts.:Pro PrEAWnm BY nil DEPARTMENTOF LOCAL GOVERNMENT FP'ANCE IC 4-1.1-2:4.1
Gibsatl County Auditor
101'N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt or this deduction becomes
more beneficial.there is more incentive than Baer 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
benefit and to pnwide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kept confidential and can only he accessed by authorized county officials.The Department of
Local Govenunent Finance w ill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Moore, Jessica M
•• R.r. I.Box 262a it
Francisco /0,'
4826
Jessica M Moore
6347E 250 S -- State Parcel Number Legal Description
FRANCISCO IN 47649-9062
26-13-30-200-001.409-004 002-01409-00 PT NE NE 3029.82 AC
ItlFFilFFtlt lltt tlttlitlttltltt iltt FF lit FFtltlrir tlltt tlttlt ll
X D-10
PART 2:TAXPAYER INFORMATION
Owner) Q55 tea - First Middle Last
'le Address(number and street.city,state,and ZIP code) — — _ - — - Er-Sanraiprterriad-drEsi -- -- - __ - — —` - -
U341 C aso S FQc\Q c& ,mil L[ J C
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sox .
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 I ' nature Date
W,
CLAIM FOR HOMESTEAD PROPERTY TAX J FORM YEAR
CREDITISTANDARD DEDUCTION
State Ficn, 5473 (8715-08)
Prescribed by the Department of Loral Ci emnient Finance
INSTRUCTIONS: See reverse side for riling instructions.
I (we) A pogi� certify th n 00/
ay of March, 20_
I (We) occupied as our principal place of residence the following described real property for which a Homestead Iml;*Tax =i sherebycladmed:
I (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 tIOWMAYNTA&YndeTroalcon tracL
-CONTRACTR]ECORDEDLj�,#.�', I, M Wal
H Urling = ixintracL Fee Simple owners name
Retxx Wa afka where contract is recorded Record number Page
1qW I'll
'ro
T—,S"p --P�gWrict
lay. t--, f—WIVA
County
Township
I hereby certify the above statements am true, correct an6completa.
ftmei nurnbw
Legal descsiptlon
[a the property in quesbon-
-131 pZOO - 001.
(cl co LM LQ �l 1t
Red properly M.W. H.. (I.C. &1.1 -7)
tfa use and portion
poition of the residential structure or the land not exceeding one (1) acre Omit ainnnediately surrounds that sb(=b" is used to pnidtios income. describe the
of ,% Wixierty utilized tD produce
surrounding residential improvements.
1qW I'll
County
Township
;. —
County
Township
I hereby certify the above statements am true, correct an6completa.
Signattue-of I "lant
4 UlEk�
Address (number arid sfrwt- ZIP C�
5y'7 E 0
(cl co LM LQ �l 1t
1qW I'll
;k-&�-OWYMI MUP"Mms- �W'W'Q- STANDAFZDCDEDUCTION'ALCOWANCE-�-�4.�,�* -'T
i�"W61N
ETAX,l R1
�12`7AT,100%3017
- �V
ASS ESSEDYALUE
;. —
�erwoa--
SIDENTLAL�-.
N
Swish" of Auditor
Data signed
_'UE,
4 UlEk�
Land not exceeding I (one) acre iminediatety
surrounding residential improvements.
Other land
(2)
n'K
Total land (fine 1 plus fine 2)
(3)
Dwelling
a
Residential improvements or Annually
(4)
M'
Garage
Assessed Mobile I Manufactured Home
(5)
W011 lk* 00 P.M
Other improvements
rip
ro,
Tctal impmvements #no 6)
(fine 4 through
ra
Toted value (fine 3 pka Eno 7)
(8)
1 hereby certify the above is true, coned, and
Signature ofAssessor
Data signed
complete.
Verifying actim - Sgreature of Auditw
Data signed
;k-&�-OWYMI MUP"Mms- �W'W'Q- STANDAFZDCDEDUCTION'ALCOWANCE-�-�4.�,�* -'T
—Ts
20_Pay 20_
Lesser of 1/2 Homestead
Valuation or MODO
Swish" of Auditor
Data signed