HomeMy WebLinkAboutHomestead_Humphrey (3) STATE FORM S1StA(0.11610) TREASURER TORN 1SIA
APPROVED BY STATE HOARE OF COUNTS,MN ?RFSCRIBW BY TEE DEPARTMENT"OF LOCAL GOVERNMENT MAVER IC 61.1-:2-.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD 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 tax bills for all;therefore,
HEA 13442009 requires taxpayers also receive the homestead standard deduction to verify that they are eligible to receive the
T IL benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
• L! - �, filings. and
information will be kept confidential and can only be accessed by authorized county officials.The Department of
1, Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1:'PROPERTY INFORMATION
MAY 4 2011 • Taxpayer Name Location Address
Humphrey, Matthew D
•
516W State
GIBSON COUNTY - Princeton IN 47670"
718
Matthew DHumphrey 110101UDI10110100011_ II0II1011110 Illoill[II01-IIIli0101101101011 mil
•
516 W State ST
PRINCETON IN 47670-1346
'Illtiiill'1111'li'lilllllllllll'1111ulllllltllllllll'll'I'li'll State Parcel Number' Legal Description
26-12-07-103-001.951-028/ DEVINS ENLG 3 PT/4 PT
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.
Ir PART 2: TAXPAYER INFORMATION
O,. - I First Middle • Last
IVNtw • NUmPi� �1
Mailing Address(number and street,city,state,and ZIP code) • Ei Same as property address "
I � w sr,
Spouse First Middle Last
Mailine Addr ber and street,eiiy state,and ZIP code) `- - ['Same as propertfaddress - - -- •
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
1I I I 11 Suez
• 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 ,
•
- CCAIM FOR HOMESTEAD PROPERTY TAX ;-..
' CREDIT/STANDARD DEDUCTION� = - --
Stalc Fonn Sa7$ (R614-03) , `
Presrnbed by lhe Departmeni of Lotal Govemmeni Finance' '-' '
INSTRUCTIONS: See revcrse side�IOr /ilinrj insfn�c(ioiis: (�
l 11
FORM I'� YEAR
d W
5'S" nFC ��n �nn�
� �e� r -_ - e - -� U - Ce���[ ,��Sh�2� ,(/ ., //
'��'19 N{jt.E� �
I(We) occupied as our pn cipai pla side ce the followin9 desuibed real property (or w'ch Homestead Ffn'sp��l'ac27rNUItYs ktlf88}p6�i fied
�I (VJe) owned � Arebuying under contracl " � ���
1 Have a beneficial interest in�the.entiry that is liable (or the property taxes on Ihe property and�that owns ihe property or is buying under a conUacl.
If buy'ug on contrad, Fee Simple ownets name
RecaNers ofice where contract is
Counry
T g dislrict
� A_Jl_.
Record number � Page
Parcel number �p Legal description Is the property in queslion:
�,�� ^ �l \ 'J �" � ❑ Real property ❑ Mobile Homo (I.C. 67.7-�
N any portion ot fhe resitlantial sW cture or Ne land not exceeding ona (1) aue Nat immediatety surtounds Nat swaure is usetl b produce income, desaibe the use antl portbn
ol Ihe property utiiized W produce income.
County
I hereby certify Ihe above statemenLs are We,�correct and compiete.
County
3 yx, t ��`-.-�'-Y'i���' ���'4"-' {��� „'���'-s'c e.s � "�'-s.� pSSESSED VACUE HOlAESTEAD'� f`� ��
. � _,�.,,,. _
�v� �ASSESSOR�USE ONLY '`'�-3 x C TRUETAX 1 � . K �: � � �s.�-NON-RESIOENTULLj n
�-?•a+i.7 � %e.� ?:%t+�:i�3�,. .'.5i'a.�--�;'�,� �.VALUE�f7.s4 .. AT�100%OFh'TN� �.c;VALU�� �s���+S�.�'^w•V-ALUE�e.:.�`_3F�'�
Land nol e9ceeding 1(onP) acre immediately (� � ;7a'����;�?'�- .Y}
surtoundin residential im rovemenis. � ,.��T', '� ,.Zm__ �
Other land (2) �� �xy���
=`.��x:R'���'
Total land (line 1 plus line 2) (g)
?�� rry.7fr.t yz�� .5���
�WC��Ifl9 (4� �r� �� . . 'i`�"1%'1C1".
Residen6el impmvements w Mnuatly �,_� �, F:
0.ssessed Modle / Manufac�red Home < �� � '- �z '�
Ga2ge (5� r .�, o
.. � . �� '.r ��!
s`fi;. 1
Otherimprovemenls (6) �;��w`. -`..' � �
Total improvements (line 4 fhraugh line 6) (�)
TUaI value (line 3 phs line � (g)
I hereby certi(y the above i5 We, coned, and Sgnamre of Assessor Date signed
complete.
Verifyifnj aUion - Signature oflwdimr Dale signed
20 _ Pay 20 _
Lesser of 1/2 Homestead
vaivauon a 535.000
Sgnatura of Auddw
S