Homestead_Brogani
CLAIM FOR HOMESTEAD PROPERTY TAX �� oRM ; Tr-YEAR
CREDIT/STANDARD DEDUCTION �� F"L Imo' I I
State Farts 5173 (R6 14-03) "--°l � J
Prescribed by the Department of Local Government Finance
INSTRUC7 ONS: see remae atria dr OV trahrrcrions AUG 0 9 2006
;C TS EMENT�r ➢
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I (We) certify thatCqrZ ,tboist :dayl6rMarch',C200R
I (We) occupied as our principal place of resides a following descrod real pmperty for which a Homestead Property Tax Credit is hereby claimed:
e) owned ❑ Are buying under contract
ikHave 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.
NTRACT .',RECORDEO'`a�cxdskitt" "--'r
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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ROP.ERTY,OWNED`BY CLAIMANT. �INOTHERCOUNTIESi >�,��3'�����4'���,�'r�3�`" "�"� "'"`dam
_ .._- DESC __
ROP, ERT, Y. �RIP, TIONes�x��..' "i3'rs- 7:�°�w��4'f'',:c����cy'
County
Township
Taxing discs (' wn, township)
Parcel number
oa
ascription
Is the property in question:
o - 3a -
+HOMESTEAD
west property ❑ Mobile Home (LC. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that im ediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
1-33
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ROP.ERTY,OWNED`BY CLAIMANT. �INOTHERCOUNTIESi >�,��3'�����4'���,�'r�3�`" "�"� "'"`dam
County Township
County Tavnship
I hereby certify the above statements are true, correct and complete.
e of cla' t
Address (number and street, city, state, Zip code)
•- rt^�ASSESSOR USE ONLY''* =`
3�UE TAX
/iSSESSED VALUE
+HOMESTEAD
"i' gINON= RESIDENTIAL
VALUE. -�'��
Land not exceeding 1 (one) acre immediatelya"
-.
surrounding residential Improvements.
Other land
(2)
till
M,
rMS
Total land (line 1 plus line 2)
(3)
Dwelling
q
-. p ""Y:itU.N�ir?"93i
'Residential Improvements or Annually
Assessed Mobile / Memtfachaed home
Garage
(5)
3µ
fF-4� �`:
� '.3.�. 0 . _
1
Other improvements
(6)
�y£
_.�c.
S
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verilying action - Signature of Auditor
Data signed
..a �-rb'�''�r,'t:31��±Z .'S`.'? � - iY�STANDARD DEDUCTION ;ALILOWANCE �r ''ti%` - "`:s "e
20 Pay 20_
Lesser of 1r2 Homestead
VNuabofl or 535.000 $
Signature of Auditor Date signed
•
MATE FORM b-w ti:/fw■ TRi STAIR rORV 7S-IA
APPRM EDDY•141E1rwRD Of AM P:NTS.!aw PAEAAmm BY mE DEPAAINCeit OF LOCAL&VELNNETT FINANCE M.-IA-224.1
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 incenthr than ner for homestead fraud.Ilomestead fraud causes higher tax hills for all:therefore.
• HET 1344-2009 requires taxpayers who remise the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings, This information will he kept confidential and can only be accessed by authorized county officials.The Depanntent of
Local Government Finance will use this infomwtion to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Brogan, David P/Carrie J
Box 326
Somerville IN 47683
3254 âf rog ' nl `•
3d0 S Lincoln State Parcel Number Leal Description l/"
SOMERVILLE IN 47683 '
26-20-11-'202-000.332-003 020-00332-00 PT NE 17-3-9 1.33 AC
-, — —
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
�\)\6 1hfL _ Teo an
Spouse First Middle Last
enxc ;e JeaA ttagon
Mailing Address(Number and street,city,state,and ZIP code) ❑ Same as m address
5S9y s -ar∎uotn st- Re EX 3q1 SOwAerv\11e_ ZN (4-7( 0a-3
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 I Signature Date
PART 4: ADDITIONAL INFORMATION ,,
40