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Homestead_Hensley (5) SIAIt FORM f!Na III/SAN) PCFSSU£rR fORM:-IA ArPRraEO BY SLATE lit NRDMMf EST C.Iwo PRESCRIBED BY TI[DEPARTHEST OF LOCAL GOSTRNMrI FASNc£ICH.1_II Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS PRINCETON IN 47670 Individuals and married couples are limited to one homestead statdand deduction.As the receipt of this deduction becomes more beneficial.there is more incentive than net for homestead fraud_Homestead fraud causes higher tax bills for all:therefore. HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to senfy that they are eligible to recent the benefit and to provide additional identifying information necesmr to allow county government to better monitor homestead filings.This information will be kept confidential and©n only be accessed by authorized county officials.The Depanment of Local Government Finance will use this information to create tools that will help count'officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION , Taxpayer Name Property Address Hensley, Clinton T 930 Mill ST Princeton IN 47670 435 Clinton T Hensley 930 W Mill ST State Parcel Number Legal Description PRINCETON IN 47670-1204 26-11-12-204-000.461-028 EMBREE ADD 8 PT PT NE 12 t n II noIr II III lu III II teIa II'un I II I II II olI 211 .46 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. • PART 2: TAXPAYER INFORMATION Owner I First Middle Last ant,Ire T(COL / Ong Address(number and street,city,state,and ZIP code) ® Same as property addtcss Spouse First 1 Middle / di ` Last an 1 /�vii n Mailing Address(Number street,city,state. nd ZIP codr;)� 0 Same as property address ---Each undersigned certifies,under penalty of penury.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. Owne Signature Date / PART 4:ADDITIONAL INFORMATION • CLAIM FOR HOMESTEAD PROPERTY TAX � CREDIT/STANDARD DEDUCTION ` � State Fmn Sa73 (R8/ 7-07) � u! Prescnbed by the Departmerrt d Laal Govemment Finarrce INS7RUCTIONS: See reverse side lor filing inshuc6ons. � F R � � MAY 2 9 2009 � (;IBSp N COUNTY AUDITOR �(we) f � certiiy thal on tfie 1 st day of March, 20_ �(We) occupied as our prindpal place of residence fhe fdbwing described real operty tor which a Homestead Property T�c Credit is hereby daimed: r. I(We) owned ❑ Are buying under contract ❑ Have a benefiaal interest in the enfity that is IiaWe fa the property taxes on the property and tliat owns the property or is buying under a contraG. I1 WyinB o^ conire0. Fae Simple rnmela name Recardefa office where conUac4 is recwded Counry Twrnship town, Rewd number � Pape Pa�cel number egal description I Is ihe pro�ty m 9uestlon: .�i (D �� Q.�J 8�T �'f �vE� � a_.� _ R R�� o�,� ❑ M�� „a o� �-,.,-n tt erry porUon of ihe residential sinxture a Ihe Wnd nd exceetling one (1) acra ihet immediately wrtounds Ihat sVUCtura is uaed to produce inwrtre, describe Ihe use end portbn d Ihe property uUGzed Ic produce inmme. �- �l -��. - a� K- o oo. 41v� - v�-- 8 ,_ , . . .. . . „.. Land not ex�ng 1(orre) acre immediatety ,..A- � r. y.- �,5..�.:. M„�.^, sunoundirgresidentialimprovements. �� -_�?�'� �""'� OtltetWM (2) - _ - _'-:�'t a� Tdal land (line 1 plus line 2) (3) .� +r :y, t � :. Residential improvements w Mnually Dwemrg (4) 'M1i r -a� -.-.> +c `�` , a- . �.,'• AssessedMo6iielManufacWredHome � ��'�"'-",.��t� ��,�-�:, Gara9e (5) � ��` �,4.�.� < ��3'-w ,, _. n�2.a,.M..�c:.:c•:i_..�-,s;at�... ��z � � r : �• �;,r,�. Ofher improvemenLS (6) � f-;,: �" rr� .�;,s7Y TUaI improvements (line 4 through Grre 6) �7� TUaI value (line 3 phs li/re n �g� I hereby certify Me above is true. correct, ard Sigreture of nssess« Date si9ned (monN. daY. Y� c«nplete. Veiiyirg atiion - SipraWre of Audilw Dale signed (mmN. daY• Yea/) �.-� � � � • p— PaY Z� — qs.ppp tor 2007 pay 2008 42,000 for 2010 pay 2071 Lesser of 12 qq.000 tor 2008 Homestead ValuaCOn PaY Z009 41,000 for 2017 pay 2012 5 « 43,000 for 2009 pay 2070 40,000 payable after 2072 Sipnatura of P� Date signed (month. OaY• Yea�l