Homestead_Embry Wit FORM Sera I C1 W) 1RF_'SULER FORM APIMOVEDOY
NOTICE TO HOMESTEAD PROPERTY OWNERS a
Gibson County Auditor
101 N Main
-s" PRINCETON IN 47670 Individuals and married couples arc limited to one homestead standard deduction.As the receipt of this deduction becomes
p more beneficial.there is more incentive than eser 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 teethe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filintts.This information will he kept confidential and can only h accessed by authorized county officials The Depanmem of
Local Goscrnment Finance will use this information to create tools that will help county officials eliminate homestead feud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Embry, Richard A/Patricia A
R 3 13ox 6613
Oakland City ,'
1851
atricia A Embry p��
R 3 B 4`fDr{' S Ts.le t a- State Parcel Number Legal Description
akland City IN 47660-7650
I I I I I I I I III I I I I I I V I I I 26-13-34-400-000.297-006 003-00297-00 PT SE SE 94-2-91.771 AC
��. ru nrt ur n nr nr r ut rt ut nu nt t t
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
t Card A1�z7J EI,'xbr�
mg Address(number and street,city,state,and ZIP code) ® Same as property address
4 4 otk S .TG Ie ;Q or. - Oa i ,zN 41 • --
Spousee First .. Last•
1 o-trtlQIA A Mk E mbr1
Mailing Address(Number and street,city,state,and ZIP code) IYl es
Same as properly address
U t/a d C, Tle;cab 17..oaL-m.1et., , TN, 97610 /� _ '
_ - —
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.
O' eT• I Signature Date
-
•
a'^a CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
y CREDIT /STANDARD DEDUCTION HC10 9
State Form 5473 (R2/1 -90)
° INSTRUCTIONS: See reverse side for filing instructions.
CERTIFICATION STATEMENT 1,51992
I (We) _ = certify that on the .1 da of far
f(We) occupied as our principal place of residence the foll ing described real property f(AUD mestead
rr'roperty Tax Credit is hereby claimed: (We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
property or is buying it under a contract.
CONTRACT RECORDED
If buying on contract. Fee Simple Owner's Name
Recorder's office where contract is recorded Record Number Page
PROPERTY DESCRIPTION
County Towns Taxing District (City, town, township)
Parc I Nugb& _ ,,, Legal Description _ a_
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that struc-
ture is used to produce income describe the use and portion of the property utilized to produce income.
o;e- 12 -3 as -OGY6. � �) 7 Gee�
PROPERTY OWNED BY.CLAIMANT IN OTHER COUNTIES
County Township County Township
10 hereby certify the above statements are true. correct and ' - Sig t re
complete.
Address (Street. number, city, state and ZIP code)
if
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE HOMESTEAD VALUE NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements
Otherland
Total land - line (1) plus line (2)
Residential improvements - Dwelling
Garage
Other improvements
Total improvements - line (4) through line (6)
Total value - line (3) plus line (7)
'
(1)
1991 Pay 1992
Lesser of 1/2 Homestead
19— Pay 19
Lesser of 1/2 Homestead
Valuation or $2,500
(2)
Valuation or S1,500
Valuation or $1,500
(3)
Signature of Auditor
(4)
- - -
-
(5)
(6)
(7)
(8)
1 hereby certify the above is true,
correct, and complete
Signature of Assesor
Date Signed
Verifying Action - Signature of Auditor
Date Signed
STANDARD DEDUCTION ALLOWANCE
1989 Pay 1990
P'Lesser of 1/2 Homestead
1990 Pay 1991
Lesser of 1/2 Homestead
1991 Pay 1992
Lesser of 1/2 Homestead
19— Pay 19
Lesser of 1/2 Homestead
Valuation or $2,500
Valuation or $2,000
Valuation or S1,500
Valuation or $1,500
Signature of Auditor
%prar�te Signed
/tJ— .S— D,
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