Homestead_Hartley (6) STATE FORM!lW IK!W*) 77.EA5t1AQ Po0.V TS-IA
APPRMEO DV 5T•E BM RD Of"MA iNTt:on PAN(WBm BY TIM DEPMIARYHE Lrit1 LOVaNSITI.,ETAWR 1C 6-11.1-r 4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 • Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than eser 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 arc eligible to receive the
benefit and to provide additional identifying information necessary to allow county government ro better monitor homestead
filings.This information will he kept confidential and can only be accessed by authorized county officials The nepanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY LNFORMATION
Taxpayer Name Property Address
Hartley, Scott A
318 W Glendale ST
Princeton IN 47670
2316
Scott A Hartley
318 W Glendale ST State Parcel Number Legal Description
Princeton IN 47670-1220
lirtitittlrill IIIttItttltll 26-12-06-303-001.523-028 SW PAR VIEW 42 AC43/6/7 PT BLK 2 PT
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
crx; (LPN NARTLEY
-- .g'Address(number and street,city,sate;and ZIP code) — — '-Same as property address ---– – — — --- • .
Spouse First Middle Last
Mailing Address(Number and steel city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
scat
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 Date
•
Yy rt�� � CLAIM FOR HOMESTEAD PROPERTY TAX
����� CREDIT/STANDARD DEDUCTION
�,• State Fortn 5473 (R2 / 5-92)
uo
INSTRUCTIONS: See reverse srde for liling instructions.
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r -. �:, --. �" � _ _ : . v: ; .•. � . �, �.-.: - ' '� �"�CERTIFICATION STATEMENT:" � - , .. � �, .•'• . :. � _. . �
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I(We) c iry that on the 1sf,day of �March, 19
I(We) occupied as our principal place of residence the tollowing d ibed real property for which a Hom ad Property �ax Gedit is hereb�laimed:
[] I(We) owned ❑ Are buying under wntract GIBSOt� M' �r 7'���� I'�'TCR
��Have a beneticial interest in the eniity that is liable for the property taxes on the property and that owns ihe property or is buying under a contraci.
- '-. • ^ �. ��CONTRACTRECORDED_�,,, :�:�.:'�I.d� ti. : �r. ` ..'^"- .
. ... .. ,.. .. .- . _. ...._.. _.. � ,. ,. .". _ ....
If huyirg on coniract, Fee Simple owner's name
Recorder's oflice where contraa is recortled Record number Page
I
Counry Township
Legal descnption
� � y-�ii�a�s �c,vi -1'�z
If any portwn of Ne residential strudure or Ihe land not exceeding or
of Ne propeM utilized to produce income. ��
ESCRIPTION�� ° _`-:_..'.,:
Ta<ing tlistrict (city. rown, township)
mmedia[ety' surtdmtls Iha� structuie is used
6-a-iv ,lby �C.
■
�
= �.;su� a
income, describe ihe use antl portion
�'" � � - � � � � � `PROBERTYOWNEDBY�CLAIMANTINOTHERCOUNTIES� `. � � - �
Couniy Township Counry Township
I hereby certify the above statements are irue, wrrect and complete. S' namre ot iman2
ress (numb ndsne t d. tate, ZlPwde)
s�e _ ,,.� ;;ASSESSORUSEONLY '.� ' � TRUETA% .� �ASSESSED HOMESTEAD .. ..NON-RESIDENTIAL�.,
. , .. ...: ., ..— � '.. � � _.�oVALUE" ' � -VALUE: . -YALUE � . . ; ' VALUE �. ' . -
Land not exceeding 1(one) acre immediately �' - � '
surrounding residential improvements. (�) � •
� j�.^.;�<:. ..�,<, _
Otherland (Z) ° '
oJ y,�l�.-,��•
Total land (line 7 plus line Z� (3)
Dwelling (4) � . � � ' �
Residential impmvements - .. -
Garage (5) . ' . , .
Other improvements (6) � -
Tmal improvements Qine 4 through line � (7)
7otal value (line 3 p�s line � (g)
I hereby certiry the above is true, correct, and Sgnamre oi nssessor oa;e signed
complete. '
Venlyi� adion - Signature of Auditor Date signed