Homestead_Gray STATE FORM 535M1x51840) TREASURER FORM TS-IA
• APPROVED aY STATE BOARD OF ACCOUNTS,MN 'RFYRIBFII BY THE OVARtMEST OF IOCAI.GOITR\MENT FINANCE IC 6-11.12-Lt
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,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore,
sfr ° HEA 1 344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
I E D 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
local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORi%IATION
MAY 4 2011 . Taxpayer Name Location Address
C- ,r •• -Gray, Gerald G
v �\ 10243 E 350 S
GIBSON COUNTY AUDITOR OAKLAND CITY IN 47660
4959
II_I[III_VIII�III� IIII�I I��III
. Gerald G Gray I II�IId�II�ILIIIIII�llII I_ it�Il�if lluhI II
10243E350S
OAKLAND CITY IN 47660-8416
"'illll"lll'lllllllll'I'�'111111'lll'll1ll1llllrIlrlllllrrrllli State Parcel Number Legal Description
26-13-35-200-000.057-006/ PT N NE 35-2-9 3.22 AC C-1
. f/
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 Z:TAXPAYER INFORALaTION _ _
ov.. __ First - -- . Middle Last
&er � ( e . - Gema G.rc 7
` Mailing Address(number and street,city.state,and ZIP code) - ® Same as pro address -. •
/0.2c'$ Lr is-0 S. ®agLam el C', T 7 • rN. 4f766 0
. , G
•
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 5 digits) " Other(please specify in Part 4 below)
I I I I I Ste
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
F
property
residence, or has - beneficial.interest
II
CLA[jM H()<"ESTEAD
��.ua0_ol
PROPERTY TAX
CREDIT FOR YEAR 19—f
USE ONLY
Li J/
K FOR F1 1NG INSTRUCTIONS3 21--07 003- QUO S _pp
I, Ink-) certify that on the 1st day of
Y' h, 19 , I, our principal place of )dance the following described real
®�erty which a. Hanestsad ?roperty Tax Credit is , being
I, (Hie) owned'
0 are buying t~ "-=, contract ko/
have a baamf4.cial interest in the taxpayer v
Property iption
P Descr ien � coon (7'Gc.vrn� Tloymstnip
Taxing District (City -Town, Township)s'
Parcel thrix -tr or 1lialyd�escription scram on tax stet amts
If_ buying on con tzacu owners name: -(fee simple owner)
Contract recorded in Recorder's office - Record No. Page
If any portion of �the.residential structure or•the land,'rot exceeding one (1) 'acre that
immediately surrou nis'that structure is used to.prioduce income, describe the use and portion of
the property u3ti u�iliiu i to produce income.
Any other counties in %hick individual owns or is buying real property: ooh Township
certify the above statement is true, correct and complete•
�D���������2 /2 / 60
=signature street Address -City, state and z' a
*Individual either owns oi is buying uner a contract that provides -
property
residence, or has - beneficial.interest
H.
FOR ASSESSOR S
USE ONLY
True Cash
Assessed
Homestead
Value
Valuation
Valuation
Land not exceeding 1 (one) acre kmx)diately
surrounding residmtial, inprovements
(1)
1,26
Total Land
3)
0
07-90
Residential Inprovements
Garage
(5)
j.
1/111110 //11
Total
Wier irrprovemients
_M
390
I hereby certify the above
is trust correct, and
couplets.
Date
- ACTION BY AUDITOR -
Date:
Approved: