Homestead_Miller (16) NIAm FORM!ma I teel NNI TRF StIEER WRM 75-IA,
APPRovED BY cr•TE BOIRDOr Nrillnil,`nv MLYRIBW BY TIDE DEBARIVEYCOF LOCAL GOVERW.n.T IM'CE R'1.I.I4_4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PR 476 Individuals and married couples are limited to ore homestead standard deduction.As the receipt of this deduction becomes
_ more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
® HEA 1344-2009 requires taxpa.ers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information recrsare to allow count'government to better monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Department of
LULU
APR 7 Local Government Finance will use this infortmation to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
VTaxpayer Name Property Address
GIBSON COUNTY AUDITOR
Miller, Ron/Judy Gail
240 S Seminary
Princeton IN 47670
1060
Ron/Judy Gail Miller
240 S Seminary State Parcel Number Legal Description
PdncetonIN 47670-2120
26-12-07-401-001.804-028 019-0180 -00 HOWES ENLG 5 PT/6 PT
t I il t a lire t ill t t nr ll r ill lliset I seII
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
Owner I / First n Middle ///� / Last
�/(/�/"�Ofafd (pie./I in / I /leV -
�ng Address(number and street,city,state,and ZIP code) ` // 4 Same as property address
2 y0 S. Seniinor Sf A—ihcdd-ot-I , -TIJ x7670
Spouse First Middle ��j / Last
Jfn Jr g a //4
I ll&k-_
Mailing Address(Number and street,city,state,and ZIP code) n in Same as property address
i(O S. Se�,rnary Si: , Prim Y7670
. . _ _________ _________ _
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 eliuible 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.
Ov.. 1 Signatlue 'Date
•
a^`� i CLAIM FOR HOMESTEAD-PROPERTY TAX � - FoRM YEAR
s��� CREDIT/STANDARD DEDUCTION HC�o .
.�:���� State Form 5<73 (R2 / 5-92)
�au • . _ . . � . �
INSTRUCTIONS: See reverse side /or filing instructions. _ �f
� - " � � � � � - � -CERTIFICATION STATEMENT � � 4 � " -
��'i- Ne) . . _ .- - certif � at on the t d `ot March, 19
e) occup ed as our prin i I place f esidence the following describedreal property for which a Homestea�����C� claimed:
❑ 1 (We) owned ❑ Are buying under wniract _ � , , , _ �
❑ Have a beneficial interest in the entity �ha� is liable for ihe property taxes on the property and that owns the property or is buying under a contract.
- � . . .. CONTRACTRECORDED..- . � � -
If buying on wn(rac�. Fee Simple owner's name . - . � . .
Rewrder's oHice where contract is recorded Record number Page
� " � - PROPERTY DESCRIPTION�
Counry Township . Tacirg district (ciry, town,
Par�l'u er D��� �O Legaldescription �
U
If any portion ot the residential structure or the land not exceeding one (7 � acre ihat immediatety surrounds ihat trw
ot the pwperty utilized to produce income.
lb_,2� .
is us d to protluce income, describe ihe use and portion
OWNED BY ClA1MANT IN OTHER COUNTIES
Gounty
�reby certity the above siatements are true, correct and complete.
Address (numberandstreet clry, state, ZlPcode)
zY° S• SevH/NQry �,-,:,r��
claimant
Township
.. - ASSESSOR USE ONLY �,� TRUE TAX � ASSESSED HOMESTEAD NON-RESIDEN'fIAL
,VALUE VALUE. VALUE � VALUE �
Land not exceeding 7(one) acre immediately ' �
surrounding residential improvemenis. (�) � �-
Otherland (p) � �
iotal land (line 7 plus line 2� (3) .
Dwelling (4) �
Residential improvements .
Garage (5� - , - �
Other improvements (6) � _ .
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line 7) (8) (
I hereby certify ihe above is Irue, correct, and Signamre of Assessor Date signed .
complete.
"ryirg aaion - Signature of Auditor Date slgned
�_
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52,000
S
ALLOWANCE
SignaWreo(AUditor Datesigned _ I, J
.'
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