Homestead_Shomate STATE FoRM•”.0t:/}NI LMFASCLER FORM ta-IA
.Arrrm'EO BY STATE&tUUM Ann Nit ry,h PrniUDFD BY 11W1-DEPMT NT OF LOAtf.In21SNIfXT ra:.AA'CE R'♦I.1.r.s.l
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to or homestead standard deduction.As the receipt of This deduction becomes
more beneficial.there is more incentive than eNCr for homestead fraud.Ilomestead 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
filing.This information will he kepi confidential and can only M accessed by authorized county officials.The Depannrnt 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
Shomate, Carl D/Janet S
RI Box 10
Oaklan ny IN 47676
60-9701
4300
Carl D Shomate
133 S 1150E State Parcel Number Legal Description
OAKLAND CITY IN 47660-8605
�r�n��ur�lflu Fllnll ntln�u��u��n111111 ��u I��u11Ill 26-13-12-400-000.817-006 00300817-00 PT SE 12-2-99 AC
C-1
• � 5
PART 2:TAXPAYER INFORMATION
Owner I First Middle
A- L Last
be ;5 d, Snam ,9- 7 -
erg Address(number and srrceS city.state,and ZIP code) -- - - - — —-- Same as property address
/ 33 S // SoE 0 CAL b C ,riy c/ `/ 7GGo
Spouse First Middle Last
TA Al E-T Sum SN M A-(6-
Mailing Address(Number and street,city,state,and ZIP code) ❑Same as property address
1 3 3 S, 1.1 So KL,Az d/7- 1�t-. V 7 G 0
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 I Signature Date
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Fonn 5073 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for ffffrta Instructions.
FORM YEAR
H 'r
Etb::]
31
I (We) ` 1?�- ���• ---QJ certify that on thpoiaroh` 20
v
I (We) occupied as our principal place of residence the following described real property for which a Homestead Probe(Q�NTiVr6WWi5Rd:
❑ I (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 under a contract.
''.'i�c+t *.t...�.`a�r s?i 's.- ,rlt. °8 ?'�?•a rCONTRAC_T.;RECORDED rt,I�':v'.::yt#F.�'.�'sF ,�..- a'o&�.zF$..ts:L'JS~J.:.r �'�rsa•t
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
.- -.��r `*- •��= .- �e�:- .�"'Y. s'-ry,. : �s"+ �;,se- "TPROP,ERTY:DESCRIPTION�^ �` ;\
County
Township
T
ot (rafy, Town, owpship)
X
hereby certify the above statements are true, correct and complete.
Signatur claimant
Pitrml number �%%�
Le escriptlan
Is the property in question:
— o `-'
0!1 /y
Real property ❑ Mobile Home (I.C. 6.1.1 -7)
If any portion of the residential structure or the Land not exceeding one (1) acre that immediately surrounds that stfucturs, is used to produce income, describe the use and portion
of the property utilized to produce immrm.
(2)
_- :�..r`t�'��: _7.z`�x5.`PROP.ERTY,OWNEDI,BY CL'AIMANT:IN'OTHER'000NTIES
fF` T` x' :''._e>s,a"�'i, ".$t`.r,'Sm
County
Township ,. , _
County
Township
hereby certify the above statements are true, correct and complete.
Signatur claimant
Address( ber and street, city, state, ZIP code)
/fit f o
,,' - T
7c-'6 o
T .a
L ASSESSOR'USE ONLY :3 i t
N i ', l`ig;ss ;��; _ s„zray
� `TRUE TAX s-'
•r- VALUEss
ASSESSED VALUE
AT.. 100 %.OF TfVx�VALUEc;
+HOMESTEAD
NON�2ESIDENTVIL"$
2,��r�-- '3>.VALUEl..efi`
Land not exceeding 1 (one) aae immediately
epib
"'
surrounding residential improvements.
(1)`,a
+.
Other land
(2)
j'=;t
..r- xzzLrw.
Total land (line 1 plus line 2)
(3)
Dwelling
(4):',,'�..,'
sr y
i* c1r
Residential improvements or Novelly
--^O"f �d.�' �•�•
"
Assessed Mobile I Manufactured Home
Garage
(5)
s
�,r.:
Other improvements
(6)
.'r,�y"��.-' °✓
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line n
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Dale signed
20 _ Pay 20 _
Lesser of 112 Homestead
Vauatim or S35.000
Date signed