Homestead_Gray (3) •
ttATE Porn snGIR_l f••l tarAAItrR FORM TSIA
A,rrr ED BY cl ATE MMHB Or ArrobNR_204 PRESCRIBED BI'TIE BITARTM:Yrfi LOCAL CAVER.YV,FNI FIANCE ICbl.I-L`-$J
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 es er for homestead fraud.Homestead fraud causes higher vas hills for all:therefore.
HEA 134 4-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recene the
•' benefit and to provide additional identifying information nett.sary to allow county gusernment to better monitor homestead
filings.This information will he kept conlidential and can only he accessed by authorized roomy officials.The Dqunntent of
Local Government Finance will use this information to create cols that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Gray, Gerry/Susan G
P O 13ox 184
Oakland City IN 47660
5037 -- — - — - - — - — - — -- — --- --
Gerry Gray
619 W Cherry St State Parcel Number Legal Description
OAKLAND CITY IN 47660-1217
1111,111111111.11111111 26-14-18-103-000.589-006 003-00589-00 PT NW I&2-83.88 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
PRY 1 N C'Ry
.le Address(number end street,city,state,and ZIP code) U-Same as prajreny address - - _ — — —
�/ 7 . 4.1e-x71- G h E, R R y kJ,h dt C.AV/ ¶ 7660
Spouse First Middle Last
Mailing Address(Number and street,city,state.and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Driv'er's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sec
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 deduct ion.on.this property..Fach.undersiened also understands that,.by.claimingadditional.homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Owner I Signature Date
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HCto
State Form 5473 IRS 110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
"_1 . . . 1C
1 .. . .:.
7e- e� _ -,- -', ER FICA ON STA MENT'�
-44 � TI TI TIE
I (We) L� 4ww 1) cl 2
1 (We) occupied as �0� — st that on the st a . of MaZ, ' �2
our princ pal lace of residence the kl.13�119 described real property for which a Home ja_ka� - rned.
El I (We) owned ❑ 6 AUDITOR El Are buying under contract GIBSON COUNTY AUDITOR
a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
C 0 NTRACT! R EC 0 RDE D�I,ift-
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
c 6 Fv� r-4,".- .. — . --
'" � '
PROPERTYDES RfPTl N
County
Township
T strict (city, town, township)
Parcel number
,4val d scription Is the property in question:
Ce)
Yt I E;Keal property ❑ Mobile Homo (I.C. 6-1.1-7)
If any portion of the residential structure or the Ian h not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized W produce income. <7 0
D D
(� /
� '-� , , "
- , - "6. ,-PR
k 6 -
�tTRUE -TW', -4.ri
'.':14P . ' - I
County
Township
County
S
Township
I hereby certify the above statements are true, correct and complete.
Sig re �nt
(� /
Iran (number and street, city state, ZIP code)
21q7' t'wASSESSMUSE 'f-wK-
�tTRUE -TW', -4.ri
ASSESSi6VAC6E
:�.i
HOMESTEAD' -INON-RESIDENTIAL
4 �-t'
CINLY�—
g�
S
F 'TTV
V!; VALU E
Date signed
Vto
'61"." �-j
Land not exceeding I (one) acre immediately
surrounding residential improvements.
F-
Otherland
(2)
Total land (line I plus line 2)
(3)
4f,
Dwelling
(4)
Residential improvements
Garage
F,
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
.aSTANDARD. DEDUCTION ALLOWANCE
20 Pay 20
Lesser of 172 Homestead
S
Valuation or 56.000
of Auditor
Date signed
Vto
'61"." �-j