Homestead_McGillem (9) • • STATE FORM!)Wtr:MMJnl lRL\SURER FORM TS-IA
.Arrnm2n PT WAIL IXSROOE wrouvrc.mW P6nYFtnm BY TIE DEPARTMENT OF LOCAL G RNMENT FIROSCE IC 6-1.1-2.4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard 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 verify that they are eligible to reecho the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kept confdenrial amt can only he accemed by authorized county officials.The Detanntent of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
McGillem, Wayne/Jerri Ann
617 S Gibson
Princeton IN 47670
3117
Wayne/Jerri Ann McGillem
617 S Gibson State Parcel Number Legal Description
Princeton IN 47670-2405
I I I I I I I I III III III I I III I I I I 26-12-07-403-001.967-028 019-01967-00 PT SE 7-2-10.12 AC
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PART 2:TAXPAYER INFORMATION
Owner I First Middle ��/ /' Last
lLa,y4e l�l✓�1/a Cur , '//er¢
- - •IgAddress(numbermld'strcc city:state:and ZIP ccdc)——— _ _ _ - _ .L�--°ae as property address_ ._ _ _-_ - _
(.0i7 S , (7,- livod gfreef- Pr; nee-told
Spouse First Middle Last
Jest1 A- nn inn GI lie yvi
Mailing Address(Number and street,city,state,and"LIP code) ® Same as property address
G i ci S' G i b s cm 9 T Inc a-c,v -1-h) Li 1 (n ) O
Each undersi fined 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�r� A -� n Date
r i
•
�vx� m. lv i�i�
?resc,ribed, By State Board of Tax C�rmissi.oners __
� CIAIM FOR HONESTFAD PROPF�tTY TAX CRmIT .FOR YEAR 19 �y -'- .�/
ii> :_ c :, ✓
�_ SEE BACK FOR FILING INSTRIiCTIONS ; rv Q�.C� `:pll,�(Q�-.O� -
: _:.:,
I.�) -- -' � C = - certify that on the lst day of
�h, 19 , I, e) ied as our princioal place of residence"the following described real .
�.�_l,.erty for whi a tead ?roperty Tax GYedit is heseby being claimed: =
I, (T^ie) [] aana3. - ' � :- _ - • ` ,
� are buying under oontract' ' . , }+ ��. ; � -
� have a.beneficial interest in .the taxpayer �,: a, , � p�� ��L . ,.
Property Description in ��� �`/ - %-a•�/ O Coimty � / /2'.�„�,.c�7�r>'� . Tc�anshiP .
.,:. . _':_.t�:.:,:>:_o::<: - :� .:: :... ..:. . . . . .
Taxing District (City, Twm, 2b�nLShip) :
Parcel Phm�ber or legal descxiption shown on tax staterent:
,.•-� ._ . � �f �`� ��i�``;`_�.' - �1/f
,:.L:.: �;..o .
' . _ ..: - .. -> ... .. . _ - . • ��,r :f` _ .
If buyina om m�tract; Owners name' (fee si�le owner) � -. .. ,.
� Contract recorded in�Reoonier's Office_-..Recrord No,.'�`. �:�'::�-:�: „ Page
If any portion of the residential structure or the land, not e�eeding one (1) acre that
im�diately siurotmds that structure is used tn produce incane..describe the use anl m*+;on of
the pioperty utilized to produce irrnme . ,.•'�:-p4
- - . --- - - - - -- - = ��-=, - - - _. -
A�+ other cnimties in which individual aans or is 1
. . _ � � � C �. � ' i
. , . �: j - , .;;.
" r� •- - .
��hy.certify,the above statare.nt is true, oorr�
_ �M''"'' `/ > �n': . -..: � . : �. - 7. i'7 � .i �;%
�
(�� .,.,,, �� -
��Y:�iw:'IAJ�!'��'�:�: P , ..
, i5 _� �. r -- . -
���^F r � "
cong>lete.
�''= -
, . . ��,,. . -
nature . �..:.: � -•: Street Pddress � z�• �;-t c--- City., State arrl Zip Coae .
*Individual either aans� or is buying imer a mntract" that'provides he is.�to'pay the �:`-_ ;' ``
ProP�Y: taxes_on the.residence, or has a beneficial'. interest..in.:the::taxp3Yer. `--
-..._.,..:. ,. . ..
. � ,' - FOR ASSESSOR�S USE ONLY - � , � z . , -:: --. . , .,_ _-:
- . ,,,tr: -
: . 7Yve Cash;l���el-�-.•Assessed .- itanestead �.
- _ t.;. .,
" - " Value -- Valuatiori '�: �.. Valuation
Zand not exoeeding 1 tone) acre inanediately , :� /�.
surrow�ding residential i�mvanents :: �_ (1) , �.cl � � � � d
Otiies Land . . _ ._ - . . . ' (2) ' — . — _
Tot�r�a.. c3) �93=a '�io:�.
Residential IrtQmverents � ' �ll�q (4) �� % g'7 b t? ' /
.: - Garaae ` .., . (5) .: ,�. E;
�r�. c6� �-?8i-o"- - '���;oo' ..` a�oo
� - c,� —_ , ° =_ ' - .
orn� ���� . ,.
�.
To';� y I�rwenents - Line (6) plus (7) equals (8) (8) � �% 8�/ d _" � �,� �
�' � and lete - � _ : � , �.: . .. _. .
I hereby certify the above is true."co�rect. �
— • I�te -
- ACTION BY AUDITnR -
?�roved: � Date: