Homestead_Ambrose STATE FORM 535W mime) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.Emi • PRESCRIBI])BY THE UFPARTMEW OF LOCAL GOV!R.M VTFINANC IC61.1.2241
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
FILEDbenefit and to provide information ide additional identifying info necessary to allow county government to better monitor homestead
filings.This information will be kept confidential and can only be arrr'ccrd 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. -
JUN O 1 2011 Taxpayer Name Location Address
C Ambrose, Debra Gay
1218 5 Prince
GIBSON COUNTY AUDITOR - Princeton IN 47670
1332 IIu i I I-VI 011111 II I II Ii n i i II IIllI
_I m fiDit mDDI uIIDebra Gay Ambrose
1218 S Prince
Princeton IN 47670-3014 •
I'I"III'IIII"'1111" 'IIIIIIIIIIIIItlllllll'Ill'IIIIIIII'IIIIII State Parcel Number Legal Description
26-12-18-203-002.670-028 ADD 66
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 -
Owner I First Middle - Last
SE6teM - � � y - 19mBROSE
Mailing Address(number and street,city,state,and ZIP code) Same as property address
/218 S . PRINCE_ 5T, PRINGGTON, jW 417670
Spouse ft/ vs First) .. A/ Middle 4/9 Last
( ,i ds - _. —r _ ,Y..- ...-_ t.-_ Sa address r•_--- i
Atslling�Address ANlmibcr.and strccl.•clry;state,and ZIP codcj -. - -!-1'....me as property ad_ess' _ � a --fir-
/Y/4
.
-
Social Security Number(last S digits) Driver's License/State ID Number (last 5 digits) Other.(please specify in Part 4 below)
I I 5sitc
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.
• - I '
�r A Date
- - - -•
r7 nc - . E, ?00 9 d- ,--2 O /D
--....._ - -- -- - — - —
� � CLAIM FOR HOMESTEAD PROPERTY TAX
'} CREDIT/STANDARD DEDUCTION
� State Fortn 5673 (R6I403)
Prescribed by the Department ot Local GovemmeN Finance
INSTRUCTIONS: See revcrse side lor /iling insiruclions.
FORM YEAR
HC10
11 Tr" � T--• _�.1
�
� M�e) ������u" �/ /�� w`""�C certiry lh�V6nithe115tjd��Aarch. 20_
I(We) occupied as our principal place o( residence the following described real property (or which a Homestead Property Tmc Cr/edit is hereby daimed:
❑ I(We) owned ❑ Ne buying under contract �/ C.� /, �
, Have a benefiaal interest in the enti that is liable for the ro e taxes on �he ro e �` ��'"'� "�
ly p p rty p p rty and that owns"the:properry br �s.burng � der a conVaU.
i
If byv�g an contraq. Fee Simple ownefs name
Remrdels ofice whe+e mnVact is recordeA
�� Y: i�`=�/� °t'� �''�:-�?k�'_U_�.-_x ��'-�' ".'hc'��a¢
County
Parcel nurty}F,7� ��� �O
v
Tamship
Legal description
If any poAion o( Ne residenUal sW cture a Me land not exceeding one (7 � arre that
ot ihe property utll¢ed to produce income.
Tavnship
I hereby certify ihe above statemenfs are We, corted and complete.
arMSheetdty,s(ate ZlPcnde)
� f? S �.ti...,; .
Tating tlistrict
/ � Ils Ne
�O
County
Record numUer
Page
in question:
I aw v,oaem ❑ nwe�ie Homo �i.c. s,.
is use0 to produce income, describa the use and portion
�70
.,�"• "a°" �a�s�,..s,..'�LG�? ^- , s�, �r s �.h+.� . -...r �-,._ t � ..a -
'`+�x ASSESSORIISEONLY �� TR�ET�` 3 .,A�,SSESSED�VALUE�HOMESTEAD`��,�' �"NON;RESIDENTIAL �;«
rt ������� �VAI.UE � ATa100/aOFTTV»�. ac!�,�YVALUE� `����rc�3�`�"�VALUE��Yi�`�,���`:�
�i-;t� :."..�_a.F:'�.T:.��',;,_."R:` .;o ,�r.- - -s�-.u.e
Land not exceeding 1(one) aue immediatety =�i�,�'�Q,��� �P.�:�.�'�.sF!'!�
surroundingresidentialimprovemenLs. (�) ���t3��.'��'�y`W `r'�' t� �
..$:..�,.-.._,�cL,.�ssr :�Q'vk.�.�'
�� �µ�I � �
Otherland (p� �=n �
�-'�: �R'�
ElcLik'_.
Tatal land (line 1 plus line 2) (g�
- w ;rR ,F '�-••_
s� � }•' ��{� �'`x
Dwelling (4) '�"�i'"��i�°�"a.�.s�t.�t�.�V��
ResidentialimprovemenfsorMnualy �`�"�'`�F�"°' r;
0.55essed Ala011e I Marwfaaured Hmie Gara e y�g,, �� r=.`, _� - c_
9 �5) � 3i5�8h���-ni.�� ���„ i
_,ts�. J _.v
.��.'. ; ��;��
Other improvements (6) ���''�';�=:�'s
� _.a:..�3`v"'�s'm.,�s
Tdal improvements (line 4 through line 6) (��
Tdal value (lina 3 plus line n (g�
I hereby certi(y �he above is We, corred, and SignaWre ofAssessor Date signed
completa.
Verifying action - Signature o(lwdiwr Date sgned