Homestead_Byers' - - STATE FORM DWI PO/r-1% IRFASUREE FORM TSIA
APPROVED BY STATE BOARD OF ACCOUNTS,209 PRESCRIBED BY THE DEPARTMENT OF LOCAL CA\TA\MEYTFLYAWV IC6L1.f-tI
Gibson County Auditor 1 IMPORTANT NOTICE TO HOMESTEID 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 lax bills for all;therefore,
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to receive the
benefit and to provide additional identifying information necessary weans; county government to better monitor homestead
• FILED fie ngs.Th s information w ll be kepi confidential and can only be accessed by au horiz d county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
APR 2 9 2011 • I PART 1: PROPERTY INFC1R,NIATION
— Taxpayer Name Location Address
_ Byers, Adam T '
GIBBON COUNTY 405wtcenwcky
- Princeton IN 47670
3766
Adam T Byers 1111111:mil ill IDI ill 11II liii fill till IillIiiiii DIIllT liiiM flI lullii]liI I-1
405 W Kentucky
PRINCETON IN 47670-2851
'IIIIIIIIII'11"'IIIIII1'1111111tIIlII"I'II"FII1111"II'IIIIIII State Parcel Number Legal Description
•
26-12-18-103-001.731-026,PT NW 18-2-10.283 AC '
•
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.
,• F -> -- --_ . .. PART 2: INFORMATION _ _
First Middle Last— _
Mailing Address(number and street,city,state,and ZIP code) 4 me as property address
L\o5 \Ot��-- '4d ) P�;),rc� , urtiia
Spouse - - First n Middle - ' Last
Mailing Address(Number and stmt,city,state,and ZIP cede) - filne as property address
`A05 We-s+ 4_,n4J Pc' , m,Ceyor\ -IILI 1-fILQ70
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 Id t Date
Art�° CLAIM FOR HOMESTEAD PROPERTY TAX
`44"� � CREDIT/STANDARD DEDUCTION
���J S1ateFwm5473(RSI10-01)
�°� Prescribed by lhe Department of Local Govemment Finance
INSTRUCTIONS: See �everse side for filing instructrons.
::,'_-s.c".-.=:d'�.,:�r�_':e::,".r_..�:___!_,"'", :::•�'- . ronr�nrwn
FORM YEAR i
HC10
. ._ _ __._...._...._.. _...._..._... .: � el •,�..-� ..
'" '_ ' ' _ .- J �s..1 ��. .
I(VJe) f � rtify �at on the 1 st day of Mamh, 20_
I(We) occupied as our principai place of residence the owing described real property for which a Homestead Jrpperty,T�c C�gjj{Qs hereby daimed:
❑ I(We) owned ❑ Are buying under wniract
'Have a benefidal interest in the enii that is liable for the ro e taxes on the m e r� � /� � a�
ty p p rty p p rty and that ow s�,the progerty or is buying un�er ontract.
� If buying on contrsd. Fee Simple ownets name
� Recorders office whera contracl is rewrdetl
.._ °S .-.t'v .. � . .'. _. .
T hip Tanng
�
Leg d riptio � /��
sUUCture w Ne Wnd nol exceeding one (1) a�re Ihat immeGiatelr!
ice inwme. _ r5
Remrd num�er
Page
_ Y= ��. � .7�. "iS � .P'(2 ' _
OW/1, IOW �
�� v
x. question:
�Real pmperry ❑ AAODiIO Homo Q.C. 67.1-7)
swcture is used �o produce income, desaibe the use and poNOn
' � ( 7 � J w� 1�,�.—X+ 7 I
`"t '�y-'�,g "�``��ASSESSOR USE ONLY - -# a b � �i � iTRUE TAX i � �ASSESSED VACUE - HOMESTEAD , �, � NON RESIDENTIAL yY'�� -�
�4 e r�. �4 h F?+�;�.�t.'. - ;?� : � VALUE:; -AT 100%OF..TTV. F:';�:.VALUEa'a.� � :�`F._�it�.. �I'.''VALUE ��;.;::t,�C,+�`���
Land not exceeding 1(one) aae immediately (�) �ir jr �, h� � z--�*, ;��� ._�� -
sunounding residential improvements. .�..:-.�,�"� _ -'+" _ t :
��4 ri:.` `� Y� '� ' .
Other land (Z) - �� � �:;=�i 4.f:a��
- - .. i-. �.c � t
Tqal land (line 7 plus line 2) (3�
fy e�; �y i }�,� r _-�
Residentialimprovements �''"elling (4) �3A �r�,�`���� s�J�,��•,:.,
Garage .'��'��,,''�t�`ur"a'�`°��u�? a_-:
(5) ..w t3's„"��`''7`0,�._-�'�.-�',��i
- ` °�. :.:.r� � � "'�-�'!
Other improvements (6) = �-.� `:�,�,
_ :•�.
Tctal improvements (line 4 through line 6) (7�
To[al value (line 3 pha line n (8)
I hereby certify the above is W e, cortect, and Signawre o(ASSeswr Da�e sgned
complete.
Verifying action - Signature otlwdimr Date sgnea
20_Pay20_
Lesser of 1/2 Homestead
ValuaGc� or 56,000
S
�' O�
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