Homestead_Johnson (12) ' srnn roan 539443/E-10] rx`AmuX WWI rs.IA
APPRO.ED rr 75TE BOARD OF.1f(€I srt,Ili ratxRIBED BY nu.01 PAR INIE F OE LIX'.U.COyhal'sax"r ELNEECt IC al.1':+.I
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS.-, o
101 N.Main Street Individuals and married couples are limited to one homes:ead standard deduction.As the receipt of this deduction becomes
1 40 Princeton IN T M beneficial there is more incentive than ccer for homestead fraud.'lansicad fraud cances higher tax bills for alb therefore.
'HL` 4 1344.20 c reyuims laspa)en who r ceive:he homestead aandari deduction to verify that they are eligible to recdve the
cfil and m pnxide additional idcmi king inlhrmalion nwcs>ary to allow countv guvemmcm to berm monior hamevead
lilirp.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will the this information to crate tools that will help county officials eliminate homestead fraud.
APR 10 2012 PART l:PROPERTY INFORMATION; •
�$ Taxpayer Name Location Address
C n v,.��\ Johnson, Pauline M
GIBBON COUNTY AUDITOR o 7y
' 60.51AilN) s., Princeton IN 47670
IN 47670
964
Pauline M Johnson III 1:III_/III[1111�11oil0111 11111111111111111_HIIJIIII_ II11_0111101[ft liii
303 E Pinkney
Princeton IN 47670-2423
ICI'IIIIIItllIlllIllIlIIl' 'Iltlltlllll'IIII'I'IIIIIIIIIIIIIII'I' State Parcel Number Legal Description
26-12-07-403-003.376-028 CLARKSVILLE 7 PT
This form MUST be returned to County Auditor's office. o
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION'
er I First Middle Last
Mailing Address(number and street city,state,and ZIP code) S-61-the as property address
303 L , ?1 k
Spouse First Middle Last
Mailing Addtcss(Number end street.city,state.and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify, ir.Part 4 below)
I I I I I _ stem
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.
Ow - _". nature Date
'
[ RI
a� —"� i CLAIM EOR HOMESTEAD PROPERTY TAX
ir�'� CREDITISTANDARD DEDUCTION '
;�;,;�� State F9rin 5473 (R2 / 5-92)
�ii� . .
�� I�RUCTIONS: See reverse side lor filrng instruc(ions.
� oc �� - as our _ � , „'ence the f�
,� I(We) owned ' re buying under contract
❑ Have a beneficial interest in ihe entity that is liable br ihe
If buying on contract, Fee Simple owner's name � .
FORM YEAR
HC10
- certiry that on ihe 7st d�eeTTvv, ��o�f March, 79
� e cribed'rn�. tppertydor which a mesiead Pmperty Tax Cr� -� imed:
^ t.i1 �
i�
pe�Ky i ze p�rty and that owns the property or is buying under a
I l/l�
�l "���-519C�
CONTRACT RECORDED �. � _ .,. . .
number
0
PROPERTY DESCRIPTION
Counry ( Township ' . Tvcing district (c y 'aw , towryshrp) � � . -
� ��%
qa �/bC �..,� �� ' O � Legal description _ . .
y�'�
.J V.� `1
If any portion of Ihe resitlen6al strucmre or the land not ecceeding one (1� aae that immediatety surrounds [hat strucNre is used to produce income, describe the use antl portion
of the properry utilizetl ro produce inmme. .
PROPERTY OWNED BV CLAIMANT IN OTHEP COUNTIES
Counry Township Counry Township
� Sig , re of claim t,
eby certity the above statements are true, correct and complete. �
ddre;s (num r an�tree(. c',i s(ate. ZIP code) n� ` � r � � ^� , / � � �
UGV � �.. otY �"j
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTtAL
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediately .
surrounding residential improvements. ��)
Otherland . (p)
Totalland Qine 7 plus line Z� (3)
Dwelling (4)
Residential improvements
Garage (5� �
Other impmvemenis (6) �
Total improvements (line 4 through line � � (7) (
Total value Qine 3 pUs line 7) (g)
I hereby cenity the above is true, correct, and Signamre o� nssessor � oate signea
complete. -
�fying action - Signature of Autlitor Date signed
�
79_Pay79_
Lesser of 1/2 Homestead
Valuation or S2,000
DEDUCTION ALLOWANCE
S
Signature of Audi:or I Date signetl