Homestead_Smith (34) ' STATE FORM MCA(0.I/S.10) MEASURER FORM TS-IA
`" APPROVED BY STATE BOARD OF ACCOUNTS,fiW PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVEW\MEYT EINAV6.IC 6-1.1-311.1
_ Gibson County Auditor - IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
1001 N.Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton,IN 47670 more beneficial,there is more incentive than aver for homestead fraud.Homestead fraud causes higher tax bills for all;therefore,
HEA 1344-2009 requires taxpayers Miro receive the homestead standard deduction to verify ttufthey are eligible to receive the
• benefit and to provide additional identifying information necessary. to allow county government to better monitor homestead
filings.This information will be kept confidential and can'only be accessed by authorized county officials.The Department of
T Local Government Finance will use this information to create tools that will help county INFORMATION fficials eliminate homestead fraud.
��� p , PART I: PROPERTY INFORMATION
LTaxpayer Name Location Address-
MAY 4 2011 Smith, Fern Life Est
206 Johnson AVE
C.rj.lr\ Princeton IN 47670
3300 p�
Fern Smitho Life Est AUD17DR III 11u iII�II I IIIIIII I��III�I IIII��II�II_HilthiI�I�II II II I �II1II�I�II I II
206 Johnson Ave -
Princeton IN 47670-3142 '
"IIII'Ii1111111111 illliiilrtrllltlilltl"I'1III1111111111 State Parcel Number Legal Description
26-12-08-203-002.685028 /DIKE ENLG OUTLOT 1
•
This form MUST-be returned to County Auditor's office.
Please do NOT sentthis form back with your tax payment to the county treasurer.
�_ _.....�_.___:_ .--------...._PART2._1AXP.AIE.RINMR .IATION
DJS n / First D f? / Middle ^ tv �7 7 J ( Last
j' Mailing Address(number and /street,t,city,state,and ZIP code) //. Se as/prop'property/address 6�`]
av6 SohNS0Iv Avf- pg ) NCITay 1NPIAA6 v7670
: °
Spouse First) Middle - Last
Mailing Address(Number and street,city,state,and ZIP code) (] Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last S digits) Other(please specify in Part 4 below)
I I I I . I . 1 . I I I sMH
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 Si re —yi//f 4% Date
FOflM NC 10 1979
P�escribe0 By 9ate BoaiE a� Ta. Commissfaners
io Be FIW in Duplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19�� /
���' ��M� , SEE BACK FOR FILING INSTRUCTIONS 0/9- Oa (0 8 S- o a
�(We)�,1�-���� �'�'�n� tY'����+�+^� ��Eertify that on the 1st day of
�vlarch, 19�1�', I, (We) occupied as our principal place of resid nce the following described real property tor
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) Q'owned
❑ are buying under contract
❑ have a beneficial interest in'the taxpayer n
Property Description in �r County `'�'�-G�- Township
Taxing District (City, Town, Township): �/LCna.cr.�_e,— l,t�x�t_yG ��
Parcel Number or legal description shown on tax statement:
- � i�x. �n�..�n .tA. d c. .�.C+r-� ��
If buying Ofl contract: Owners name ��� simple owneq
Contract recorded in Recorders Office - Record No. Page
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 indiui�ual owns or is buying real property: County Township
;hereby certify the above statement is true, correct and complete.
�' �P.�i/ R��f��rw-��n� A.R_4 Si�:I.:. ,�,e�
S�gnat Sheet Aaor s. ity. Scaie ana m Cotle
' Individual either owns or is buying under a contract that provides he is to pay the properiy taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrountling residenti�im�overr�nts � �
Other Land �
Total Land
Residential Improvements -'v��?E�y��
Dwelling
�/////�i� .�— Garage ,
� � � '��y Tolal
Other Improvements AUDITOR
T'-` Improvements - Line (6) plus (7) equals (8)
I�by certify the above is true. correct. and complete.
oi asseswr
True Cash
Value
�,� �y�
(2)
(3)
(4)
(s)
(s)
(�)
($)
Assessed
Valuation
(D y- o
I�
Homestead
Valuation
!�,.
-/7-
oaie
� �p•�-y
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Date: __ /