Homestead_Mroz C-
c1A1E FORM!!!MLR:/wont 1RLS JRLR FORM ISM
.APPROVED BY SiAtE en.ADOFMYYR.Tt.Loos PRESCRIBED BY TOE DEPARTMENT OF LOCAL CA\_R.YNETT IN IC..I.I-r4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS t -.
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 e'er for homestead fraud.Ilomesread.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 recent the
benefit and to provide additional identifying information necessary to allow count'government to better monitor homestead
filings.This information will he kept confidential and can only he accessed by authorized county officials.The Ikpanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Mroz, Christopher A/April L
— 1802 OuterS Main
Princeton IN 47670
156
Christopher A/April L Mroz
1802 Outer S Main State Parcel Number Legal Description
Princeton IN 47670-3406
26-12-18-302-001.105-028 019-01105-00 PT SW 18210 .45 AC
V
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
( w\s -o Rt,2A ( M rat
g Addrcv(number and scree[;cite;state;and ZIP code) - - Sums its prnperty'u;drca— - - —- - .—
S053--L I-w ■ SE- P1'ssitaton1IM P7 r?0
Spouse First Middle Last
Ae,11 L Mro�
Mailing Address(Number and street.city,state.and ZIP code) lgf Same as propene address
lib 504-k Pc-;.1cerbq r s Lill1lla'70
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 Signa Date
e`�% ��°, CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
..e •
CREDIT/STANDARD DEDUCTION HCio
.,
.�%� State Fortn 5473 (R2 / 5-92�
yu .
INSiRUCTIONS: See reverse side !or liling instructions.
I(We) U � certify th�1ythe�t�t d@��BMarch, 79_
�) occupied as our principal place of r sidence�the following described reai property for which a Homestead Prope�ny Tar Creaii is hereby claimed:
�(We) owned ❑ Are buying under conUact � �� (,/{� D
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that.owns t e pwperty-oris•tioyu;ic}�fidAd �tract.
Lr��;- .– . . . ,::plTO�i 1
� � � - � CONTRACT RECORDED � � � - � � ` � ' -
If buying on coniract, Fee Simple ownefs name �
Recortlefs of�ice where contract is recorded Record number Page
PROPERTY DESCRIPTION
Township
V l�`�JiJI 1 ` Y 1 Lk� U/
Parcel numbero/ � O�� � egal de tio � � , ) / � I � — / �
P In/
� V \!
It any ponion of the residential siructure or the lantl not exceetling one (71 ave Ihat immediatety surmunds that structure is used ro produce
of ihe pwperry utilized to produce income.
��
describe the use and portion
� - PROPERTY OWNED BY�CWIMANT IN�OTHER COUNTIES � �� �
Counry Township County Tmvnship
�eby certiry the above siatements are true, correct and complete. Si nre of ciaimam
��
ddress (numberandsbeeG ary, state, ZlPmde)
. � �f N U �1 b-[
ASSESSOR USE ONLY TRUETAX . ASSESSED HOMESTEAD - NON-RESIDENTIAL
� VALUE VALUE. VALUE VALUE �
Land noi exceeding 7(one) acre immediately
surrounding residential improvemenis. (�) ��
Otherland (p)
Total land (line 7 plus line 2� (3)
Dwelling (4)
Resideniial improvemenis ,
Garage � (5)
Other impmvements (6) -
Total improvements (line 4 through lina � (7)
Totai value (line 3 p�s line � (g)
I hereby Certity �he above is true, corrett, and Signamre ot Assessor Date signed
complete.
Verifying aaion - Signamre of Auditor Date sgnetl
�
19_Pay19_
Lesser of 1l2 Homesiead
Valuatipn or 52,000
STANDARD DEDUCTION AILOWANCE
5
Date s etl � I �
trm Sr'�