Homestead_Smith (66) STATE FORM Me TRFAR:RFD FORM TS.IA
_s+*:� EPPROVFD BY STATE BOARD OF ACCOUNTS.1039' PRESCRIBED BY THE.DEPARTIVE YOF LOCAL GOVERNMEVT FINANCE IC 61.1324.1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 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,that is more incentive than ever 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 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
FT E Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud. `
1 PART 1: PROPERTY INFORMATION
Taxpayer.Name Location Address ,
APR 2 5 2011 ,. - Smith, Sheila S .
919 S SEMINARY
C. '
_ - PRINCETON IN 47670
_
12 COUNTY AUDITOR
a pph
- _
C,O Habitat For Humanity II_Illlllfill Illfil lull flu 11/1111 IlIll flI fill11111111111 mill 1011II11111fill 101111
PO Box 153
Princeton IN 47670-0153 - -
IIIIIiIII'ilia"lilIllii'illlNhIIltillllilIllIiltlllliiIililil State Parcel Number Legal Description
26-12-18-201-000.149-0280/, SS ADD 161 PT/162 PT
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:
r 1 PART 2: TAXPAYER INFORMATION .
p ,�/ First ' Middle '& Last
•
Mailing Address(number and strec city,state,and ZIP code)' G ' ❑ Same as property address
R 2 ,
-
Spouse First S Middle .� Last
r �l 'jLfi� `2�J-
''' Mailing Ad/dies;(Number and stree4 -,state.and ZIP code) -~. -
'•-7-7-4"- `---,El-Same as Property address - -7 , ,- ---
•
Each undersigned certifes,.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 maybe liable for back taxes and substantial financial penalties. - .
Owner 1 Signature - Date
-
r
�� "�" - CLAIM FOR HOMESTEAD PROPERTY TAX
i �
CREDIT/STANDARD DEDUCTION
.� �,
State Fortn Sa73 (R2l 592)
J'��'
INSTRUCTIONS: See reverse side /oi filing inshuctions.
FORM
HC10
YEAR
o��o�
�CERTI C TION STATEMENT
I(We) Q �� � certify that on the 1st ay o ch, 79_
I(We) occupied as our principal place of residence the foilowing described real property for which a Homestead Prc��7a�c F�ke��eereby claimed:
❑ I(We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entiry that is liable for the property taxes on the property and that owns prope or�� b� unde co act.
CONTRACTRECORDED
If buying on contract. Fee Simple ownefs name
Recorders oftice where convad is recortled - Record number Page
PROPERTY DESCRIPTIO
n1f/ � TownsttiP Ta�ting ist' �(� fown. townshiP)
Parcel nu r Legal descripuon
' O�
It any portion ot Ne resitlential strudure or the land not exceeding one (7) acre ihat immedatey surtounds ihat suucture is used to produce income, tlescribe the use and portion ot
the Pmperty utllized m praduce income.
� PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Si ture ot ciai am
�ereby certify the above statements are true, correct and complete. ��'/ S '
!
Address (num6erandstree(, city, SWfe, ZlPCOtle)
/
ASSESSOR USE ONLY � TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not ezceeding 7(one) acre immediatery �� �
surtoundin9 residential improvemenis.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwellin9 (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvemenis Qine 4 through line 6) (7)
Total value (line 3 pfus line 7) (B)
I hereby certify the above is true, covect, and Signamre ot Assemr oace signed
complete.
Verifying acuon - SignaWre ol Autliror Date signetl
STANDARD DEDUCTION ALLOWANCE
19_ Pay 79 _
Lesser of 1/2 Homestead �
Valuation or 52.000
Signature of Auditor Date signcW