Homestead_Lee (2) CLaTE FORM:We.it_l}Wr TRENSISER FORM D5-IA
ArPmXED BY STATE BOARD OF M OUNIt.BW PRESCRIBED BY TIE OEPART•efE WLa-U CAVSR`1MFta F11:.1SCE IC LI.142-1.1
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 ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
el
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 gmenunent to better monitor homestead
filing,,.This information will he kept confidential and can only be accessed by authorized county officials.The Department of
Local Goverment Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
—. Taxpayer Name Property Address
Lee, Deborah K yia id g, lis7
1=N Tors 6)..f.""
243 1i /7'/CL/I'► Li J1 V
Deborah K Lee (�/ Y766
4113S SR 57 State Parcel Number Leal Description
OAKLAND CITY IN 47660
003-01022-00 PT SE&PT SW 35-2-9
:1 30.1769 AC C-1
ZiA-/3 -Jr-Voo-oat•
- - - - o-as-o o6-
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
DeaS b M-4
ig Address(ntunbv and street,city,state,and ZIP code) -- • _. - - - - - /I�D�m property Bddrc __ - ___
//-3 �`�C S 7 ��2.�� (.cam r
Spouse First Middle Last
Mailing Address(Number and street.city,state.and ZIP code) 0 Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
—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 nature Date /
•
:OR9 HC 10 1979 to De i1J.c1 :.n LjLu:liC L
?rescxibed.By State Board of Tax Comnissioners
CLAIM FOR HUESTEAD PROPERTY TAX I TOR' 19�'
SEE BACK FOR FILING INSTR IS O03'o�oaa -o0
bN
Any other counties in which individual owns or is buying real property 'coon Township
I'eby certify the above statement is true, correct and con�lete
*Signature Street Address it` : City. State and .Zip Code
*Individual either owns or is buying uner a contract that provides he is to pay the
property taxes.on the.residence, or has a beneficial interest .in :the. taxpayer..
FOR ASSESSORS USE ONLY
...Tnie Cash :.;::.,: Assessed Homestead
Value Valuation Valuation
land not exceeding 1 (one) acre immediately :.,:..
surrounding residential irprovemnts
Other Land (2)
Total Land (3)
Residential "Inprovements Dwelling (4) 22 7729
Garage (5)
Total (6) / a 7 %
Other lmprovenents _ (7)
To_ - Inqmve ants - Line (6) plus (7) equals (8)
1 eby certifyy the above is true, correct, and amplete.
( / Date
Signature of Assessok
__ACTION BY P.UDITOR -
certify that on the 1st day of
r +a 19 1, (We) occimied as ours
cin ace of residence the following described real
property for which a homestead Property
ax Cred t is hereby -being clai1Te :
I owned
are buying under contract
have a.beneficial interest.in.the
taxpayer. ;.
Property Description in
County ' E �' L 1� —c�J Township
Taxing District (City, Tom, Township)
R ..
Parcel thmiber
or legal description shown on tax statement:
If buying on contract: Owners name (fee
simmle owner)
Contract recorded in Recorder's Office -. Record No."' Page
If 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
Any other counties in which individual owns or is buying real property 'coon Township
I'eby certify the above statement is true, correct and con�lete
*Signature Street Address it` : City. State and .Zip Code
*Individual either owns or is buying uner a contract that provides he is to pay the
property taxes.on the.residence, or has a beneficial interest .in :the. taxpayer..
FOR ASSESSORS USE ONLY
...Tnie Cash :.;::.,: Assessed Homestead
Value Valuation Valuation
land not exceeding 1 (one) acre immediately :.,:..
surrounding residential irprovemnts
Other Land (2)
Total Land (3)
Residential "Inprovements Dwelling (4) 22 7729
Garage (5)
Total (6) / a 7 %
Other lmprovenents _ (7)
To_ - Inqmve ants - Line (6) plus (7) equals (8)
1 eby certifyy the above is true, correct, and amplete.
( / Date
Signature of Assessok
__ACTION BY P.UDITOR -