Homestead_Smith umt rUtS9w,,,,,, TREASURER MN:}IA
.S1.190%En By ttSTE BOARD OFAn-NASA AN PREMIUM BY 11W DEYMTWVT OF LFMAL COVER:NEAT FINANCE ICLI.I-L'-r.l
Gibson County Auditor
11 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sundaN deduction.As the receipt of this deduction become,
more beneficial,there is more incentive than eau for homestead fraud Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2000 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
filings.This information will he kept confidential and can only he accessed by authorized county officials The Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
_ Smith, Anita K
115 S Campbell HLVI)
Ilauhstadt IN 47639
7379
Anita K Smith
115 S Campbell Blvd State Parcel Number Legal Description
HAUBSTADT IN 47639-8162
IrlrllllrLlrllr rrrllrlr lrr lrFlrllllllllrr rrll letllllltllllllll 26-18-36-403-000.693-009 013-00693-00 WEST HTGS 4TH ADD 19
V
PART 2:TAXPAYER INFORMATION
Owner I _ First Middle Last
/�
1�tg Address(number and street city,state,and ZIP code) - - —i-_ — -- - --'Same as pro ferry address -
A, ' cC�mzj..lt..,x3,c2 . V%% 3 9 -
Spouse First Middle Last
4v/a
Mailing Address(Number and street.city,stale,and ZIP code) ❑ Same as properly address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specie'in Part 4 below)
snit
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 Signature., �,�/ Date
(
PART 4: ADDITIONAL INFORMATION
•
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION
S•Pta Form 5473 (R71 S-M
err P esubed try the Deparlunent of Local Governeent Fnance
INSTRUCTIONS: See reverse side for (ding ins6wcaDris. FILE D
/I CERTIFICATION STATEMENT
I (we) Z��& -- -- certifyo that nt 1 90of March, 20
1 (We) occupied as our principal placeltofresidenoe the folionving described rrij propp�,- for which a Horrits bea"JB?-eer`Y
Tax Credit is hereby claimed:
I (we) owned ❑ Are buy *V under coribritcl
Have a beneficial interest in the entity that is liable for the property taxes on the property and that cm4N9AWe4WTs)W"ua*f a omtnact-
COWRACT-RECC.-DED,''
N buying on contract- Fee Simple awnees nom
Pacorder's office where contract isnxm Record number Page
'?r� ijl OpjR'TY OWNED CLA6IANT IN OTHER COUNtIES
•County
PROPERTY OESM - - , - 1. � �"' - _ "V' -Z..
PTIOw,
Canty I"?
Township
Tmamg district (ci�K fin-, townsimp)
(0 16 15 (/X1
Signottue of claimant
I
PaMal number
descfi is the property. pmlion:
Reel pi-party ❑Mobile Fleets (LC. (i1. 1-7)
If army portm;7-cd the residential structure or the land not emseduig (1) acre that suncundis dug Atrudiure is Used to Produce income. desmbe the use and portion
of V)'Propmy utilized to produce inconme.
%`- .-
7.
Land not exceeding I (one) acre invnediately
CZ
'?r� ijl OpjR'TY OWNED CLA6IANT IN OTHER COUNtIES
•County
f
- 71iUETAi",'
Township
County
Township
I hereby certify the above statements are true, correct and couiplete-
Signottue of claimant
•AT.100%.OFTrV
6 /&—
(number and 3fteeI c,6� state ZIP code) •
.:"ASSESSOR
f
- 71iUETAi",'
ASSESSED VALUE
j)
jN4R - ESH) r ENTLAL
i, - VALUE:
VALUE;
•AT.100%.OFTrV
VALUE
, - -
L " . - .
%`- .-
7.
Land not exceeding I (one) acre invnediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (firm I plus fee 2)
(3)
Dwelling
(4)
Residential aripmvernents or Annually
Assessed Mobile I Manufactiffed Horne
j
Garage
Other improvements
In
Tctal kripruverinents (Ikie 4 ffmnzh tine At
1(7)
Total value (firm 3 plus Em 7)
(8)
I hereby car* the above is true, correct. and I Sittrabins of Av r
Date sired
complete.
I
j Qatw -wr-i
Verifying action - signature of Aucftx
- — --------- J-
20 Pav 20
Lesser of 1/2 Hannesdapf!
Valuation c 53.5.000
Signature at Auditor