Homestead_Hartman w _ cnn CORM•J,-IR'/fW) MEASLIER FORM 15-IA
APPROVED BY STYE WWII)OF nmc 1'.9rN PtrnBFP BY rut DEPARMIEVTOF LOCAL GOVERYMLLT FBc%CE IC 61.1-2:4 I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple 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 causes higher tax bills for all;therefore.
•} HEA 1:144-2009 requires taxpayers who receive the homestead standard deduction to serif}that they our eligible to reeehe the
benefit and to provide additional identifying informaton necessary to allow county government to better monitor homestead
filing,.This information will he Leg confidential and can only he accessed by authnrived couny officials.The Depanmenl 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
Hartman, Scott Allen
619 l3 Emerson ST
Princeton IN 47670
916
Scott A Hartman
619E Emerson State Parcel Number Legal Description
PRINCETON IN 47670-1901
Itlttlllttll Ill tllrtlll Minn IIltlIIIlIlll ll111 26-12-07-204-000.097-028 019-00097-00 NS LOT 1 PT R2
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 , I Last
S TT l n_` i I�%l) Gild iet m q,J
ng Address(number and stmt.city,state,and ZIP code) kg Same as property address
(019 6 m62sNd s% pR wc E card IN (176, 70
Spouse First Middle Last
/1/4-)//3( WPC N/A
Mailing Address(Number and street,city,state,and ZIP code) Same as propeny address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
-- ------PART 3:CERTIFICATIOA -"'---' --' - -- -
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 Signature Date
S
`°��°o YE R
: CLAIM FOR HOMESTEAD PROPERTY TAX FORM /�,�
� � CREDIT/STANDARD DEDUCTION HC10 I-\ b b�.
� J State Fortn 5473 (RS / 70-01) � � � �
���� Prescribed Cy the DeOariment ot Local Govemment Finance
INSTRUCTIONS: See reverse side /or filing inshucfions.
�4.,�v �. � - ,_..� t.� ,���-+--r Sr': � .-.,.,,._.. .... . .
,r� w's:.J.�.: t :e..,. .3!'-�f i.'�s. . �� ... � . .�.x-=, CERTIFICA710N STAlEMENT?: `•-�':� �, =` �-: ... . .
.. .___ .:-��� . ..-.�� Ali+� � -
I(We) �� � Ie-� certify that �he 15t� da�y� f March, 20
'�, I�) occupied as our principal place o�nce lhe following described real property for which a Homestead Prop �c C�eMU�er dai �d:
(VJe) owned ❑ Are buying under contracl G'9SOP! C�! �^!TY p,Un�Tr,q
,��ave a benefidal interesl in the entity that is liable (or the property taxes on the property and Ihat owns the property or is buying under a contract.
�i'•,��a_-°cc�.'�.i���''2-�:':��`�..a''�`sir:ti�'.��.i. ���`-��CONTRACTRECORDED��>`h_�i�•-ti �h. �i ..<., •+-1'..+.'.� -
- . . .. __ . .. _ . _ .. _,_ _ .. . � . .-: -. .-.
II huying on contrad, Fee Simple ownefs name
Recordefs office where conUaq is remrded Rewrd number Page
County
Tavnship
Parcel number Le9al descnption
� l `t • �o o9'Z �o
(ciry, fown, fownship)
Is the O�operty in question:
❑ Real DroOerty ❑ Mobile Homo (I.C. 67.14)
If any potlion oi lhe resideniial sWClure w Ihe land no� ezcaeding one (1 � aQe lhat immetliately surtounds ihat sWCture is used �o produce income, describe Ihe use antl portion
ot the property utilized tn produce inmme.
Couniy
I hereby certiy the above sWtements are W e, wnect and complete.
cit}; stja(e, Z/Pcode)
'��inr�u,�.�z�'�=�� .a?F-�� ,.�- ,f �iA+{a7'.� °r-TRUETAX , . .. . i, � .. . . y� ...-
.�- '�ASSESSOR USE ONLY ��� r`«� it z k ASSESSED VALUE +HOMESTEAD� NON-RESIDENTIAL
'�fn��i��a`A..'�'s-u^'iei.�. +Y.'�`_-s':'S'� „Y�.ti.?�.L'r'...: r � `'r�i+. �, VAL:UE} z.zs �`AT 100%OF'TTV -`YVALUEt'-sc�. ���'`�,-��- � o�VALUE'� :.; �
_.t... , if.�T.rt'... ....r-..i.°... �:��.r��.r.+ .� �.�:ur_St�br.
9 ( ) Y ( � �. {- �t ��tr L�`�'.�:r" �3i`�.
Land not exceedin 1 one acre immediatel ' E�' �, �' +� x
surrounding residential improvemenls. ,_,y�,�„�,, py„� � --yr��_.
t ,°� � : i.
c �^'
Otherland (2� �g���r �„°,.r.,�
.�.r ..'
�.. Fsv�`w".P.'�:. Y'rc�c
Tdal land (line 7 plus line 2) (g�
iS'� r�`T',�,� y c-t i.t'} ;Ky rs �'T
Dwellin9 (4) �t a�,,•f,P?,;� t�`�� x,3u,�C
Residentialimprovements ;��#"�";�"'"�'''� ��"°i'�t�s�'
;`�. � `' ���4'^t���s-r'..
Garage (5� M1_r ^ct���•V�.�„r., �o "''�'.
s.,�.r ^`:..q„!',:.�fi.-�".�;:
Other improvements (6) Yy�� �w�" ���i �
t-�.�� L��
= rY,
TUaI improvemenis (line 4 fhrough line 6) (7�
To[al value (line 3 plus line � (g) �
I hereby ceAify the above is We, correU, and Signature ofassessor Date signed
complete.
Vai(ying aclion - Signature oflwditor Date signed
�?�+i�S^��.'t�.`1;-�-.af`�z...•«�P""�il,'*I.�-N?y�t.'�'�"#.�`.�_��STANDARD:DEOUCTIONALCOWANCE� ...X.��'i3%`i�.�+'v{c.::��.�i "'',��..�.'��`:e"�:ne��.�'"t_-....:
" 20_Pay20_
Lesser of 1f2 Homesiead 5
Valuatlon or 56,000
SgnaWre oflwd"aw Date signeA
�— �� ..