Homestead_Ivy (3) • STATE RMM V.Vn,R3l -lul TR:ASURIR IMW IS-IA
APAnetDOY t,1E 30\ROOF.utt.k:N.1W+ FRIV'1011EDtt THE uLPARTMLVIOk LOCAL GOVER.ML\'t IL\4%CLKl1.1u+:
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD'PROPERTY OWNERS..
101 N. Main Street Individuals and married couples are limited to one homes Sad standard deduction. As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial.there is more reenlist than ever for hontslead fraud.Homestead fraud causes higher ms bill:for all:therefore.
HEA 1344-1014 requires taxpayers who ref:lye the homestead standard deduction to verify that they are eligible to teethe the
benefit and to provide additional identifying intlmmatnm neees,an' to allow county government to better monitor homestead
filings'this information will be kept confidential and can only be accessed by authorized county officials.The Depanmeat of
al Government Finance will use this information to create tools that will help county officials eliminate homestead baud.
�' PART I:PROPERTY INFORMATION: __
Taxpayer Name Location Address
Ivy, Raymond Wayne/Mary Jean
APR 9 2012 17155 MAIN
C n,Ir PRINCETON IN 47670
1330 VV 1I II I Diu II II �I Ii
ii ON COUNTY AUDITOR (III I IIIIIIII III I mil I��IIIIJ OIIOII�IIII WI�I II III ILI�I III II.I�II ill
Raymond Wayne Ivy
1715 S Main St
PRINCETON IN 47670-3403
"III"IIII' 'IIII"I'lI"lIlrllill11nl1tllllIl""III"'lII'I' I State Parcel Number Legal Description
26-12-18-302-003.082-028 BROADLEIGH PARK 12
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 : • -
erI First '_ / Middle Last
'Pas.y ri1 p n CI ✓`r�y rl c_ �V y
Mailing Address(number and street,city.state,and ZIP code) j�Same as property address
17 / 5 5 , U'lec n Si
Spouse First Middle Lit
Mer`.
Sea_ v
Mailing Address(Number d street.city,state.and ZIP code) l�l 171 Same as property address ,
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
-
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
` State Fmn 5473 (R8 / 7-07)
� Prescnbed by Ihe DepartmeM of Laal Govemment Firiance
INSTRUCTIONS: See reverse side /or filing instrut6ons.
��
FORM
HC10
YEAR
I(We) TT C.L�Y71�' lLl � I// l.[/«Jt u0/�/h �.�11�(�1' cR�ry'{y�AR nlheolSlOd�ay of March. 20
I(We) oaupied as our rindpal place of residence the fWbwing d real property for wh' a Homestead`P�7ro�perty T�c Gedit is hereby daimed:
, I(We) owned ❑ Are buying under contraU �'(� ��
� Have a benefiaal interest in Ne entity Mat is IiaWe for the property faxes on fhe property and that ow676�Qf0{�H�I,piTsib�fit�I56U3r a contrad.
If Wy'vig om m�Nact, Fee Simple oa+iers rmma
Recadefc a45ca whare comrxd is recordad
Caunry
Twmship
If any portion of ihe residerNal sirucWre or the WAd na �ceetling one
d Ihe property uli6zetl In pmduce inmme.
._�. _ �
County ToNnship
1 hereby certify the above siatements are We, correct and complete.
(number arH 4reeL dty, s6te. and LP code)
Recard number
Page
ITanng disUicl (dfy, fosvn. tvxnship)
��!I�S Uie prapartyin tion:
` OL a�� W�rtY ❑ Mobile Home (IC 61.1-n
�hal immetliately wrtounds Uul struclure is used tu pmtluce inoome, descnba Ure use and portion
•' �
� � . � � �
i�'. •
Land not exceedirg 1 (o�re) aae immediatey ;r `} �' �r �;Yr'h S : - ` ., '� �'
surtoundirg residential improvements. ��� _,�� ; -
Other 12nd (p) � -;•. .+r � i"
�: =:%-:
Tdal laml (1'me 1 pluslne 2) (3)
' � f 'Nf� ,{'. t
Residential imprwerrents aMnualy �Ilin9 (4) �' ° *�.;xr+c�{ .� � : �- .+::'
Assessad Mobile I Manufach�red Home ' �„y�-`. �� > �_� -;
Garage 5 :i,� , r �., � >° ,s ,. 5 +.�+, .,
( ) � ._is,i.'?=-s:r:'�,�':.
ONerimprovements (8) �_���y�,Y;�,.�4..,��' - - �- �
Tdal improvements (l'me 4 through Gne 6) �7�
Tocai value (line 3 pl's Grre n �g�
I hereby certity the a6ove is true. correct. and sipnawre afACaessor Date sgned (month. day, yea�
complete.
Veriiyirp adion - Sipnahue of NWNnr Date signed (mmN, daY• Y�/)
� �Y Z� — 45.000 for 2007 pay 2008 42.000 for 2010 pay 2011
Lesser of 12 qq,000 for 2008
Homestead Valuation �Y Z009 4� •000 �or 2011 pay 2012 �
« 43,000 for 2009 pay 2010 40,000 payable after 2012