Homestead_Simon •
VI is FORM!,,MOC'PTwt • TrASUtIR FORM ZIA
sr/ROVED BY MATE BOARD OMr01 Nr5.1nr, PEFRRIBED BY THE DEPARTMENT OF LOCAL COVELNMEFr FINANCE ICH.1224.1
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 lac bills for all:therefore.
al HEA 1344-7009 requires taxpayers who receive the homestead standard deduction to verily 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 Lepi canlidential 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 nanny officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Simon, Corey L/Leah M
109 S Eileen
Ilaubstadt IN 47639-8114
2734
Corey L Simon
109 S Eileen St State Parcel Number Legal Description
HAUBSTADT IN 47639-8114
26-18-36-404-000.187-009_ 013-00187-00 PT SE 36 311 LOT 109
I t I I I nr Ir II ra I I t I t I n I n I nn I I nt IIt I III nt'r I n I n I r I ,I5 PT/111 _ _— _
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
CAD fe \3 Lea SkrnOn
�Ig Address(number and sueeL city,state,and ZIP code) .'Same as property address
(DCt S G■keev- /Vie_ -HmJc \t ** I tN {'1(0 39
Spouse First Middle Last
e,CLV\ 1 t
�M\C—(1e_ Sat ,/Y‘.0rl
Mailing Address(Number and street,city,state,and ZIP code) 2 Same as property address
[ oCt S C ,\ee 2 Poi e- a M *-0444-1 cN 47 39
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
i
ti� t CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HCto
e J State Form 5473 (R5I 10 -01)
Prescribed by the Department of Local Govemment Finance
.........,...,.., w. —,c.m uo muc w, uuug mmrucuuns.
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I (We) certify that Ap* Ett&eMirch, 20
1 (We) occupied as principal place of residence the following described real property for which a Homestead Property Tax Credit's hereby claimed:
❑ 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 49M!0`54 un co act.
If buying on contract. Fee Supple owners name
Recorders office where contract is recorded Record number Page
-- ,..-_ ._ PROPER _.�_ -
a+rv. ?TY :DESCRIP.TION,2�'�`�';.3}'�5.:
�w-6V. ' W .r.
County
Township
Taxing district (city, town, township)
P cel nu ber
L I de 1 1 Is the property in qu on:
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�' I
eat property ❑ Mobile Homo ( /.C. 6-1.1 -7)
If any portion UK r 'denial structure or the land not exceeding one (1) awe that irnmediatel surrounds that structure is used to produce incwne, describe the use and portion
of the property utilized to produce income.
...:•t5,x�.'�, ���.'- �. �PkOP ,ERTYOWNEDTBYCL''AIMANT;IN. OTHER `COUNTIES'�.,.,2�'�= �- y�.•*�_. �`..f"4r 3t�=��'�,,���°�3
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
ig u f claims
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Aid g(eyr er ai(ds cdy; ate, ZIP code)
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c 3
3
ASS Wait. " -sy 7.'
en`s
1 TRUEcTAX+
�VALUE`-.�`' X"
ASSESSED VALUE
- AT.i100Ye OF TTV�
4HOMESTEAD�-
_VALUEL'
:° NONRESIDENTIAL � ua
VALUEI,;^ a3
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
y•n'A.•,4
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
,
r4 3
Garage
(6)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
'
Total value (line 3 pits line 7)
(6)
hereby certify the above is true, tarred, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
rtM; 4ja 6V tSTANDARD '.DEDUCTION'ALLOWANCE?A?
Mir 20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or $6,000 $
Signature of Auditor Dal signed
r -ab -off