Homestead_Grimm STATE FORM 53569(R3/8-10) TREASURER FORM IS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-1.1-22-8.1
' IMPORTANT NOTICE TO`HONIESTEAD PROPERTY OWNERS
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 ever for homestead fraud. Homestead fraud
Ituses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayerswho receive the homestead •
S adard deduction to verify that they are' 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 can only be accessed by adthorized county officials. The Department of Local
Goy_ ei'nment Finance will use this information to create tools that will help county officials eliminate -
homestead fraud. -
PAR'fl:-PROPER V INFORMATION -
Taauaser Name Property Address State Parcel Number Legal Description:
Janna L Grimm 116E CLARK ST 26-12-07-302-001.866-028 PT SE SE 7-2-10.08 AC
PRINCETON IN 47670
Complete and return to: I®IIOff111AuID1Dm0U 1I lIfl]IfllullU a 1101111E1111
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 J 1 1lW 11 Oe 7ll
- . PARE?:TAXPAYER INFORMATION -
Owner 1 First Middle a Las]
Qnn0._ I t-1 mm
Mailir g Address(nurrter and street,ay,state and ZIP mde)
J Same as property address
II (6 [ . G&rk &-f , Prince.�n 110 j(2670
.. Middle ' - - Last
N
Mailing Address(number and street,ay.state and ZIP code)
Social Security Hunter(last 5 diglts) Diver's License/State ID Humber(List 5 digits) Sure Other(please specify in Pan 4 below)
PART 3:-CERTIFICATION -- •_• - -- --I
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
•
. PART 4:ADDITIONAL INFORMATION
NOV 7 2012
GIBSON COUNTY AUDITOR
ME—•'� �,�,63
e/ "°Y CLAIM FOR HOMESTEAD PROPERTY TAX
iE�''� CREDIT/STANDARD DEDUCTION �C.
.�.�;� StatePOrm5473(R2/5-92)
�au
INSTRUCTIONS: See r�yerse side 7oi liling instiuctions. M� �_�
� � Nl- o�-Q�
��
fJAN 18 1994
YEAR
�1�1�1�T(1G 0-•-�
�� - ��.�i� :-� _ certi '�fMdt'dd fi� 1 st day of Mamh. 79�
�u ie as our principal place o esidence ihe Ilowing described rea�or which a Homestead Property Tax Credit is hereby daimed:
I(We) owned ❑ Are buying under contract . . . .
❑ Have a beneticial interest in ihe eniity ihai is liable for the property taxes on the property and that owns the property or is buying under a contract.
. . . CONTRACTRECORDED � � . �
It buying on contracC Fee Simple owner's name - , .
Retorder's oftite where Contract i5 retordetl Record number Paqe
PROPEHTY
Gounry
7a,cing distpct (nry, rowq. townshiP)
ra�cn/I'1''lJIOWX.� IL�\�/� '�-�L+ �� �_O�^/� OV ��
It any portion of t�e resitlential simcwre or the land not exceeding one (t) acre that immediatey surtounds that strucWre is used to produce income,
ot the propetty utilizetl to praduce income.
the use and portion
ASSESSOR USE ONLY .. � TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE� VALUE VALUE
Land not exceeding 1(one) acre immediately
surrounding residential improvements. (�� �
Otherland (2)
Total land (line 1 plus line Z� (3)
Dwelling (4)
Residential improvements
Garage (g)
Oiher improvements (6) -
Total improvemenis Qine 4(hrough line � (7) �
Total value (line 3 p�s line 7� (g)
I hereby certify ihe above is true, correCl, and Signamre of Assessor Dare signed
,,��� �com��plete.
i�iving aaion - Signature of Audi;or Date signetl
�
19_Pay79_
Lesserof tl2 Homestead
Valuation or 52.000
Sg�amre�al AWitor
''vi _ -.
�-f "
STANDARD
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