Homestead_Maxey STATE FORM Ma(N/S-10) .-REAWLP.FA FORM 15-IA
APPROVED BY ST ATE BOARD OF ACCOUNTS.Mal PRESCEIBFD BY THE OFPARWE\T OF IDGLLGO5fNMEYr FINANCE IC 6-1.I-U
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 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible o receive the
�� - FILED benefit end to provide additional identifying information necessary to allow county go vTnment to better monitor homestead
1 filings.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
MAY 2 'ZOII PART 1: PROPERTY INFORMATION
Taxpayer Name Location Address
C.J N V Maxey, Janet
GIBSON COUNTY AUDITOR 902 E Evans
Princeton IN 47670
3355
Janet Maxey II01�III OI11 III�I111 III I�01111�11I I �IIllI1 Jllll�ll�l.l11111 I�II011_IDIIIII Ill
902 E Evans
Princeton IN 47670-2214
'I'IIII'Illllll'III'llll1l"II"1I11III'll'lll'll'I'll'IIIIlllli' State Parcel Number Legal Description
26-12-08-301-001.451-028/LYNCH 2ND 116P1/117PT
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.
.—___, __P.1RT2:TCYPAI'TR_.I\}OR,�IAa_ION_----- — ------
Owner 1 First Middle _ Last
cT ii. - AKC
Mailing Address(number and street,city.state,and ZIP code) (ame as property address
•
Spouse First Middle Last
Mailing Address(Number and 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 in Part 4 below)
I 1 I I I I I I I se=
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 1 Signature
Date
eac ��r�
;���^ a CLAIM FOR HOMESTEAD PROPERTY TAX
'� CREDIT/STANDARD DEDUCTION
�; � State Porm 5473 (Fi2 / 5-92)
�a•
INSTRUCTIONS: See reverse side lor filing instructions.
_ , , CERTIFICATION
FORMI YEAR
_HUe1�.
�AR 91995�
c � —�: � ��,0.�.� ����4�ITQR ° �
I We certif thai o a o March, 79
�7e) occupi a our principal place of residence the fol ing described real propeny for which.a Homestead Property Tax Credii is hereby daimed:
I �We) owned � Are buying under coniract , . , _
❑ Have a beneticial int est in the entiry that is liable for the property taxes on the property and ihat owns the property or is buying under a contraa.
. CONTRACT RECORDED " �
If buying on contraci, Fee Simple owner5 name
Recortler's oHice where comract is recortled Record number Page
Counry . , . Tow hip
Pa¢el numher_ � Legal de�
S
If any portion of the residential simcwre or the land not
ot the property utilized to produce income.
PROPERTY
pu,�0 I
(1) aae ihat immediatety
district�iry, ro:vn.
used
ce i�ome, tlescribe the use and portion
� . � .
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VAIUE
Land not exceedin9 1(one) acre immediately
surrounding residential improvements. (�) '
Oiherland (2) -
Total land (line 7 plus line 2� (3) (
Dwelling (4) , . ,
Residential improvements
Garage (g) . � �
Other improvements (6)
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line � (g)
i hereby ceRify the above is Irue, correct, and Sgnature of Assessor Daie signetl
complete. '
Verityirg action - Signature ol Audiror Date siqnetl
— _ I
19_Pay19_
Lesser of 7l2 Homestead
Valuation or $2,000
STANDARD DEDUCTION
S
Signamre of Audiror �� `� ��(�'{(� I Dat:sigo�
VV 1 I.�.'t`LJ��C�
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