Homestead_Botts SIAM FORM,J'Mllc It-041 TREASURER FORM IS-IA
APPRO:ED RY SIATE BMPOOE AMAIST.S.IPM PRESCRIBED BY fir DEPARTMENT OF LOAF GOVERNMEYI FINANCE IC 4-IiU4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead strident 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--2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings_This information will be kept confidential and ran only be accessed by authnriaed 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
Taxpayer Name Property Address
Botts, John A
604 N'State
..0&( Princeton IN 47670
829
John A Botts
604 W State State Parcel Number Le2aI Description
Princeton IN 47670-1348
ItlttlltrtlrIlt tlt ttlli T 26-12-07-103-003.478-028 019-03478-00 DEVINS ENLG 5 PT
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
ar9 /4 0 A- N 0/15
•ig Address(number send suet,city,stare,and ZIP code) r 9/r C ft EY I /h/ me as property address
fr 5t41t Cr 41-c79
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Part 4 blow)
sale
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 Signature Dale
• tiJ
AVE( 7 LOW
GIBSON COUNTY AUDITOR
e•—•'+
e� > g CLAIM FOR HOMESTEAD PROPERTY TAX
;��� CREDIT/STANDARD DEDUCTION .
State Form 5473 (R2 / 5�92)
.�='
aiT
INSTRUCTIONS: See reverse side (oi liling instructions.
FO � - � � � `l YEAR
l!'�67 1 O �JJ
,M", s`li.�!�'
fIIT/�D 0 �
• CERTIFlCATION STATEMENT ' -- .
e) certify ihat on ihe 1st day of March, 19�
�occ ied as our principal place ot residence ihe following described real property for which a Homesiead Pmperty Taz Credit is hereby daimed:
I(We) owned ❑ Are buying under contract „ .' .
Have a beneficial interesi in ihe entity that is liable for the property tazes on ihe property and thai owns ihe property or is buying under a contraci.
� CONTRACTRECORDED - � �
If buying on contraG.Fee $imple owner'S name . �
Recortler's oNice where contract is recorded Recortl number Page
Counry
Township
PROPERTY DESCRIPTION
Parcel6 mber Legal tlescription `
C�l � -03�(��-a0 �� �
If any portion of Ne resitlential strucwre or the land not exceedirg one (i) acre Ihat immetliatey s
ot Ne property utilizetl to produce income.
�
� � ��z
is used to produce income, describe Ne use and ponion
ASSESSOR USE ONLY TRUE TAl( ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VAIUE VALUE � VALUE
Land not exceeding 1(one) acre immediately
surroundingresidentialimprovements (�) � ��
Oiherland (p)
Tmal land (line 7 plus line 2� (3)
Dwelling (4) � �
Residential impmvements
Gara9e (5)
Other impmvements (6) �
Total improvemenis (line 4 fhrough line � (7) �
Total value (line 3 p�s line 7� (g)
I hereby ceriify ihe above is irue, correCi, and Si9nature ot Assessor Date signed
complete.
;�tyirg action - Signature of Autlitor Date signetl
l
ol AUtlilor
19_Pay19_
Lesser of 7l2 Homestead
Valuation or 52.000
STANDARD DEDUCTION
�
Date