Homestead_Short BATE FORM r e.IR_f WO T%EAAIIERr00.43IA
MK".ED BY STATE Bons of•CrOUNT5.21.r, PAE_QRIBED BY nir DEPARt5Etr OF LOCAL GOVaNMEKT FINANCE MsL1-"4 I
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 become,
more beneficial,there is more incentive than ester for homestead frond.Homestead fraud causes higher tax bills for all:therefore.
as- HEA 134-1-3009 requires taxpayers who receive the homestead standard deduction to verify that they are cligide to recene the
benefit and to provide additional identifyine information nececszn-to allow county government to better monitor homestead
filings This information will be kept confdential and can only he 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Short, Kimberly
520 S Stormont ST
_ Princeton IN 47670
1159
Kimberly Short •
520 S Stormont St State Parcel Number Legal Description
PRINCETON IN 47670-2526
._. 26-12-07-404-000.451-028 010-00451-00 MONROE HOMES 10 I tllttltllrrltrlllttt rt' Irlrlrttf tlPl t lr lllrrr'rlttl Is
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 Middle Last
Skezzz L-yr,,� 5AoXi-
�ng Address(number and street. ay,state,and ZIP code) 2-came as property address
Sao 5- 5-ide5 ,j 1 #f'.riCP7(o.✓. Ze-,-) 27/7 20
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) n Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (lag 5 digits) Other(please specify in Part 4 below)
. - _ — "_ sate__
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 I Signature Date
I
\ CLAIM FOR HOMESTEAD PROPERTY:iAX_ , -. -
CREDITISTANDARD DEDUCTION -
t � I�• Si:ne Form S17$ (R614-03i • ' ...
Presui6eC by �he Deparimenl of Local Govemment Finance' ' � '
INSTRUCTIONS: See'revcrse sidc lni liliny in.slrucfions ''� _.. .
^ - . . .. , . � . .
- T -- � .. � �-- � -- %
- � FORM YEAR
_ �
i
?%;-;� 5 ::i`r�:'iL. ".� .., t•.�%�-5 �. .. "�: .� iGER JCATION STAlEMENT� r2.,q+:°.• . �.: . � �_,.�"' .
I (VJe) � • � ' - � certiry that on 20
I(We) octupied as our principal pla residence Ihe following described real propeAy for which a Homestead P�erty T� diLiS_h bv tlaimed:
SVrv l: tJTY DITOFf
��I(VJe) owned ❑ Are yi g under wnt�acl '' �
Have a bene5cial interest in ihe entity that is liable for the property taxes on the property and Ihat owns the property or is buying under a contract.
�:�s:��:�i:''�25??�-.z scz�`,'"_�.��.`-.r3i:.'�.�' � R �-::• m,{`W"::CONTRACT.�RECORDED'te.; � �N'`.��* -- - .
It huying on conuaa, Fee Simple ownefs name • � .
Recordets office where wntract is recorCed Rewrd number Page
County
7ovnship
�//''6..t/io%v' �
If any Wrtion af Iha resiEential sWCtura w the
o1(he properry utilheE W produce i�uome. �
Is the
exceading me (1) ave t�ai immeEiatety wrrounds
town,
al property ❑ Mobile Hwno (/.C. 67.1-7)
is used b produce inoome, describe iha use antl pwtion
�'- u �r.��r� "� "�"� "� °" `�'+ i kr` ��4 '� TRUE TAX�r� ��, ASSESSED VALUE ��HOMESTEAD' ' �`+f � NON-RESIDENTIAL""`� -
Ati'...r :�°r}, s'��,�,'�AS � S�OR USE ONLY�.:..:;.'v.�{F :_,�5 .�,��s,VAI:UE ._.�.' AT 100%�TT!c� 3F���5s�VALl1E��'','. F�� �,r'S�rtiy.VALUEJ��.�.:: �-a�,ig?
Land not exceeding 1(one) acre immediately � - °».+,r t�,Z• �, a�..�k��-- ��s �i
surrounding residential improvements. � (�% ��"`y;--` �3 ��?;�. _-��`{i�'
r�-.,��.:.
� (2� a �,� ��,.. e� � --
Oiherland -
M .i� "y
.:'.i�.y v_:�
Tctal land (line 7 plus line 2) (g� �
. Dwelling �(4) r ���.`�G` !}� �} �. x�
Residen6ei improvements orMnualty ` M <�,a<.e.,,�'� .;e� ��f
Assessed Modle /�Manuf�aclured Home Garage (5) ;�� '��# Y� �{ ��� � `�?_�:
r -r.4 .�4 f .� '.i�
ONer improvements (6) `' �>: er ' � ��:
' " ...�.sL�3'....���}�.
Tdal improvemenis (line 4 through line 6) (7�
T�al value (line 3 phs line n (8)
1 hereby certify ihe above is We, corred, and SignaWre of Asseswr Date signed
comD�ete.
Veri(ying actbn - Sigreture oflwdimr Date sgned
.xs'�`-w��.�`':�t t',�':.`='.:�7�..�`t;:'sr�s;�',£<-�::'i:ST/W�ARD:DEDUCTIONALLOWANCE -��:'.=�r.-Y��<ra."' ;r_ ..-��=`*-.r�-.��.���r'%a=`�._�:,._':
�'
20_Pay20_
Le>ser of 1/2 Homesead 5
va�uauon or 535.000
Signalura af NWitw ' Date signe0