Homestead_Smith (54) A ' • SIME I ORM 53Y+tR:t awl terAsua FORM SlA
APPROVED BY SATE 001.1m Or LaitjTS.gr PAFANBW BY fir DEPARTMENT OF WALL nOVEINMTAT MQ:ANCE ICVI.1t-ii
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 eser for homestead fraud.Iomestead fraud causes higher in bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.his information will he Lepa conliciential and can only be.accessed by authorized county officials.The Department of
Local Government Finance will we this information to create tool,that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Smith, David A/Donna A
Rr 3 Box 219
Princeton IN 47670
214
David A/Donna A Smith
922 S Seminary St State Parcel Number Legal Description
Princeton IN 47670-2636
ke 26-12-18-201-002.645-028 019-02645-00 SS ADD 180
IIIr,Ilrrllrllrllrrlllllrlr1lrlTllrrllllttllllllllltllllllllll
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Diu d GI- e2 iv) i"-Fk
Ig Address(number and street,city,stale,and ZIP code) -- - ' - 0 Same as property add: - - -- - -- ---
qa ,2 -6 Semi
Spouse First Middle Last
Patin a_ .5/V1 r / r"
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
�a � J .) e rs r .51
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.
D.I Signature Date
•
wAM nc m is�s
ReuriDM By Stau�BmrE af Tax Commissoners
To Be Fi1M in WO�iwte
CLAIM FOR HOMESTEAD PROPERTY TAX CRE�IT FOR YEAA 19� f
SEE BACK FOR FILING INSTRUCTIONS D��%� OoZ�Q�S���
�(We) �� ���-=- a•�/U�^-Q - certify that on the 1st day of
March, 19—�, I, (We) occupied as our principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) L+lowned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description' in �-�-�-_-�^ County �a�f`-�- Township
Taxing District (City, own ownship):
Parcel Number
or legal description shown on tax statement:
�_s . .4,c.2. �Ro
If buying on contract: Owne s\ame ���' sim0�e o.�e,�
Contract recorded in Recorders Office - Record No. Paqe
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
�hereby certify the above statement is true, correct and complete.
County
a�r.
Township
Zb Cooe
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
� on the residence, or has a beneficial interest in the taxpayer.
FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding resitlential improvements
Other Land � � � �
Total Land
Residential Improvements
.=UN `� `� 1979
True Cash
Value
(�) // o 0
Assessed
Valuation
370
� (2,
(3) //o0 370
//'��tk�"' 7otal
�rov�rfAnts � �
T�r7
rovemen - Line (6) �I�i��11� equals (8)
certify the above is true. correct. and complete
- ACTION BY AUDITOR -
Homestead
Valuation
370
-�--� �-6�
� �
L- az-�9
.y
,
Date: L�.�-<- oZ /5'?