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APPROVED BYSISTE IIMRorwM-rr,L\Tx siv PILFSIMm BY TIM DEPARTMENT OF LOCAL coy reMrxr MB:ANCE r tI-r-&I
Gibson County Auditor• 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuate and married couples are limited to one homestead standard deduction.As the receipt of this deducion becomes
more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
• HEA 134-1-2009 requires taxpayers who receive the homestead standard deduction to curtly that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor honescad
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 1: PROPERTY INFORMATION -
- Taxpayer Name Property Address
Batey, Kristie Ann ,
— R2 Box 289
Buckskin IN 47647
8773 — --— — --- -- - - --" — -- - - - - - . -. _ _- - - —
Kristie A Batey
8647 S 850E State Parcel Number Legal Description
BUCKSKIN IN 47647-9002
1I 1rr11Lrr L'rlltt tlrtllrrlllrirt llt rtllt rt rt IrItI rtI_I trr���r1t� 26-20-27-100-000.962-001 001-00962-00 BUCKSKIN 10
� 1 si D-19
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PART 2:TAXPAYER INFORMATION
Owner I Q First Middle Last
4r∎5 e A n t HBO l
:g Address(number and street,city,state,and ZIP code) --- Same as property nddns;— — — — '-" -_
g6g7 5 sd 5 1 ac_51-7► Z ti 117697
$
First Middle Last
AJ
Mailing Address(Number and street.city,stale,and ZIP code) El Same as property address
Social Security Number(last 5 digits) Drivers License(State ID Number (last 5 digits) Other(please specify in Part 4 below)
Sme
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 Si nature Date
.
�. zr.r -
CLAIM FOR HOMESTEAD PROPERTY TAX FORA?
CREDIT/STANDARD DEDUCTION HC10 tort
Strde Form 5173 (R71 546)
Presabed by the Depertiner t of Local Govennrad F3anca
INSTRUCTIONS: See reverse side for Ring insbuctiorrs.
` . - • ... .: , .. r , ' CERWICAnom STATE RE31T.
rr
I (We) certify that on the � Insnnt��day of March, 20_
1 (We) occupied as our prun9pal place of residence the described real property for which a Homes Ta1A.61'eNt is hereby claimed:
I (We) owned ❑ Are buying under contract
Have a benefidal interest in the entity that is Bade for the property tonnes an the popery and that owns th4 or is guying under a contract.
CONTRACT: RECORDED '.;y,r
If buying on m rh Fee Simple owner's name
Recorders offioe where ombad is recorded Reuvd number Page
,. . .. . 7�
PROPERLY DESCRIP'1'IONF(. .:.`-: r a,..�.�
'. f r - r'Ai. 3,'.'• �"
Comity
Tom slop
I hereby certify the above statements are true, correct and corryfebe.
Taong district (off; torn, township)
'
:VALUE
Legal description
R the properly n question:
I ❑ Reel property
❑ Mohik Home (I.C. 6,.1 -7)
ff any portion of the residerAmd structure or the tad not eedtng one (1) acre that inmedalely unrouds Val sbumre is used to produce i corne, describe the use and portion
of the properly utilized to prod" income.
�rn auk e ,.,'1`rt
Other land
• 10
,,.. .. _
PROPETtTY OWNED BY CLAMANT M OTHER COUNTIES,
County
Township
County
Township
I hereby certify the above statements are true, correct and corryfebe.
Signature yof daimaN
:AT 100%OF TTV
:VALUE
/ (n ad street crry, stela 71Poode) '\
LoLI-1 S g50 E G�Y�d� X..v '4-7 15
'. ASSESSOR USE ONLY -:. �r
:.`. TRUE.TAX- ..
ASSESSEDVALUE
FW!!✓�S7EADi..
i „NONRES01ENilAL dr
• q
:AT 100%OF TTV
:VALUE
'� 44r .VALUE .Y
Land not exceeding I
ta'`t Yin mink;'
surrounding resdentialimmprovemen
(1)
�rn auk e ,.,'1`rt
Other land
dial land (Lire 1 pkis fine 2)
(3)
Dwelling
(4)
Residential 'improvements or Annually
Assessed Mobile I Manufactured Home
t?fi�'..
Garage
(5)
4.k, O` ^:.
OAK,
{•,..,..•fi
Other improvements
Other
(6)
y- ".i. • < %,`r.
Tatalimprovements (frre 4 through Tne 6)
(TI
TAeI value (lure 3 pus Erna 7)
(6)
I hereby certify the above is true. correct, and
Signature of Assessor
Dam s'ig
complete -
Vairyng action - Signa4re of Audmr
Dam si(phed
Signature of Auditor
,STANDARD DEDUCTIOMALLOWANCE , r
20 _ Pay 20
Lesser of 12 Homestead
Valuation or 535.000 $ -
7i