Homestead_Ayers e-
STATE FORM IR-t■r•1 MAMMA AA FORM:l.IA
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APPROVED DY STATE BoutoocAntuNT5.S0n 11.1911URED BY TIE DEPARTMENT 4 LOrALGMR6YNtWt FINANCE Ic•t.1"-tI
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 mgr for homestead fraud.homestead fraud causes higher las bills for all:therefore.
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HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to reecho the
benefit and to provide additional identifyin_ information necessary to allow county government to better monitor homestead
filintes This information will be Len mnfidenlial and can only be accessed by authorized county officials.The Depanntent 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
Ayers, John M/Shaleen L
RI Box 241 Ab
Oakland City IN 47660
1794
John M/Shaleen L Ayers
R1 Box 241 Ab State Parcel Number Legal Description
Oakland City IN 47660-8445
IJn��ul�tllntlllillntluulrrluIltlnlllllul�lIllllI�ItJ� 26-13-23-100-000.690-006 003-00690-00 S NW NW 23 2 9 20.00 AC
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
John _ mark A ers
lg Address(number and street.city,state,and ZIP code) ® Same as property address
/10 3 6 S 953 E C4144-,c1 Cr Zt/ c(-24? a
Spo - First Middle Last
h>41�2n L y hn A j'e IJ
Mailine Address(Number and street,city,state,and ZIP code) / Same as property address
7(.096 95 E ALlancL 1,966 0
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 1 Signature Date
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R., CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
�,. State Form 5473 (R2 / 5 -92)
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INSTRUCTIONS: See reverse side for filing instructions. - 1
N n'wP
CER ATION STATEMENT
YEAR
i (We) certify that on tyle.1 st.day of March, 19
I rZ o ed as our principal place of residence the following de r ed real property for which a Homestead Property Taxl Cied reby claimed:
(W owned ❑ Are buying under contract
N
LJ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns tha to' r y or isbLying undeva contract.
Y M1I10(Tc.R
CONTRACT RECORDED ; - -. '_.. - - - It trying on centram. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTI - - k -•- . - -
-r
Coun
Township
Taxing d (city wn, towns )
Township
areby certify the above statements are true, correct and complete.
Signature f laiman[
Par
I num r
Legal description
It 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.
dG- 13 - 3- 110- GU0.Z90-000
' PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County
Township
County
Township
areby certify the above statements are true, correct and complete.
Signature f laiman[
y�>ess (number and street, city stare, AZa code) �/ r
^Y�
!� /frJ C I _aj
Land not exceeding 1 (one) acre immediately
J
CWl
TRUETAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
ASSESSOR USE ONLY
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
-.
surrounding residential improvements.
(1)
- �`-'-
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line b)
(7)
Total value (line 3 plrs line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE"
19_ Pay 19_
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor
Date signed