Homestead_Small • ' MATE FORM AN/1C 1 Vw1 TRLA9RnI FORM TS-IA
APPROVED BY STATE BOARD OF AnCRAJA.gr ,.r mom BY TIE DEPARIMLVT OF LOCAL C RNMENT FINANCE M 6-1.1-4.1
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 recehe the
benefit and to provide additional identifying information necessary ao allow county grn'rmtnent to better monitor homestead
filints.This information will be Lep conlLirntial and can only be accessed by authorized comity officials.The nepanment of
�. Local Government Fin nee xvill lac Ibis inform cation to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY L\FORMATION
_ APR 7 2010 Taxpayer Name Property Address
Small, Michael J
-- gr- 611 S Gibson
GIBSON COUNTY AUDITOR Princeton IN 47670
1150
Michael J Small
611 S Gibson St State Parcel Number Legal Description
PRINCETON IN 47670-2405
�rrr�r��lrlrtr�ll trrlllrl trlllr trr lrl lrr 1I lrr tl�trl�r� K26-12-07-403-003.327-028 019-03327-00 PT SE 7-2-10.12 AC
IrIrsI
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
±c84 a -1-x S )-L
•Tg Address(number and street,city,state,and ZIP code) Same as property address
6 (1 S - G/6 66/j sr /°//L-cNcrei,J f-r/ '-( 16 ) d
),
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) ❑ Same as properly address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sale
'PART 3dCERTIFICATION --- __ -
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 l Signature i 144.0a Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
Slata Form 5�73 (R6 / L-03)
Resafbed by the DepaMxnt d Local Govanment Finarroe
INS7RUCTiONS: See rsvxp aids br ISnp iiffiudiww.
��
g�
FORM
HC10
YEAR
��e) / J/��� /��L ///� certify that dn�e 1� �y7o'PMerch, 20_
I(We) occupied as our principal place of residence Ihe following described real property for which a Homestead Propertyy yT��c Credit is hereby daimed:
�(We) owned ❑ Are buying under contract !�'�a� ��
� Have a beneficial interest in the entity ihat is liable (or ihe property taxes on the property and that owns theCpinp'eity ncfs(Miying antle�yaqqnVaU.
I( buying on conVaG. Fee Simple ovmefs name
Remrders ofice where coniraq is
County
Toxnship
Legal
N any poAim of Ne resitlen6al sWqure or the land not
ot the property uL7¢eA tu produce i�ome.
S L��'�
��� _ /,� -n � �3 -CY
Is Ihe
Rewrd number � Paqe
town, �ownship)
praperty ❑ Mobile Homo
one (t ) aae �hat immediatey wrrounds ihat swUUre is used b produca inmme, desvi6e the use and portbn
. IaQ
' �$` ' � � ����"`'�°�'�" � i�'"s �' ;�TRUE TAX xt� �ASSESSED VALUE HOINESTEAD�' 3FNON=RESIDENTIAL � �
� ASSESSOR USE ONLY•`�w�.�=�� � �' ". " _ �....__.� �l.,,,.. „ .�.� �� :�.��
�.���`".': ��g.�s;,�^v�,�r� �j �'3� j��VAI:UEy"�'�,�+. _ATt100%�_OFTN a°VALUE �� �°'t�,.,1'•`yVALUE � ". ,
Land not exceeding 1(one) acre immediately �t�, ,�-!��r"'R yy �P%�2 �r-T
surtounding residential improvements. - .� ,� s ?r�
I�J t.�'�'.t"�'":,��� �.��'Y
�4�yhi'� ��` � .
Otherland (Z) ���- �
::�"�is���'�
Tolal land (line 1 plus line 2) (3�
;��� ... � . ._: .:,w�il.a
Dwelling (4) � ��i `t i'�' ��� �r�n�
�Residentiel ImprovamenLa or MnuaOy ���` 2 c��.y
Aaeeaed Moh&e / Manufa�rad Hane Gara e ., ,.�`r. ���'�"'� '°':��` -;
9 �5) 7��'��.r�v:��"�_z���'��,����
^�,�?�-'".�.�",��-" �i
Other improvements (6) �-- �
_�'4-s-'.'�'._�`�.e_.. �s�'
TUaI improvements (line 4 through line 6) (�)
Rial value (tine 3 plts Iine � (g)
I hereby tertify the above IS We, coned, and Signature ofl�ssessor Date signed
complete.
Verilying action - SigtaNre otlwAitor Date signed
�^'��e��.,ii.�c?',r.an•�'�i;�'$?��r.�K+.��''�Ti��i.sSTANDAR�;DEDUCTION'AL'LOWANCE, -0��T-i,�.'s.i'� , � -`�'"" '�-�4Y�i�.t3'si".Ci:L?,�-- �ac"
§`�!;�sa'�"S�@efAS,-_,.......,.�.., s. sazs
- 20_Pay20_
Lesser d 1r2 Homestead $
�laluanon or f35.000
Sgnature of Auddw " Date signed