Homestead_Graper STATE FORM DSO(0.I&IR) TREASURER FORM RIA
APPROVED m'STATE BOARD OF ACCOUNTS.2009 FRESCRIBID BY THE OFPARTMENT OF LOCALOOVERNMEVr FINANCE IC 6-11-18.1
•Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
"101 N. Main Street Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
Princeton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud muses higher tax bills for all;therefore,
HEA 1344-2009 requires taxpayers who receive 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 be kept conf�drn[ial and can ably be accessed by autharired county aRlcials.The Deparunent of
i i Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
FEB-1 2012 - - Taxpayer Name Location Address
C.rJ.pA "' V Grapey, Kenneth L
-
6133E 350 5
GIBSON COUNTY AUDITOR
FRANCISCO IN 47649
4903
Kenneth L Grapey 1110111.010 0111.01111.1101011101011_ii 011011_ii:11101]iii ot110011011111 11 II
6133E356S
FRANCISCO IN 47649 '
State Parcel Number Legal Description
26-13-31-200-000.019-004 PT NW NE 31 2 9 too 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.
,, -'\T._ — PART 2; TAXpAtER.LFORMATION,:-.._ - — -- -- - --
Ov -. First Middle --- - Last
_
KENNETH L , &RAPER
Mailing Address(number and street,city.strata,and ZIP code) ❑ Same as property address
6.133E 35v S FRAMe/Sec MI , 1/76 /719
Spouse - First , Middle Lad
— Mailing Address(Number and streeC'city,state,and ZIP code) - - Same as property address -
-
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
1I I I I 1 I ' I I state
• 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
C.!, CLAIM FOR HOMESTEAD PROPERTY TAX a.\ FORM YEAR
,' CREDIT/STANDARD DEDUCTION HC10
v.._ State Form 5473(R6/4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
4s'_:s61ki"-u t7-41 i + ',s,Or2-5.:7'.: ,r zs . r --CE;r FI ON`STATEMENT.T qg„ a. r ri -r;4 i S•r1- '- s
(We)_ r/ _7l /I��L/�. ` 'lily�t tf1e 1 t day : 20
I(We)occupied as our principal place of residence the following •escribed real pro•erty for which a Homestead Property Tax Credit is hereby claimed:
L� I(We)owned ❑ Are buying under contract l o • 0 9 2004
Have a beneficial interest in the entity that is liable for the property taxes on the property and that • , he property •r i/ying under a contract.
nIBaON.000t 7
} e' ' ?+ 'S K t R"i YTT^r'f�. y AUDI(aR '=*i °'°rti r'5
.?=' `�}'�..n..�. ��,.__,sc�. �c��1�'--�-.-'`�`'a"�.�x'.C�i�`�:�J.`S.c:.CONTRACT.-RECORDEDY,vi-c .�z�Y. `s_ti?iKt'�a�xi�y. 1.,y,.-._.�_ .t.r. _:�t;d..
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
;'% 9C ° ,,'r%:-.3 4.`:t._;fi-±: ;:r PROPERTY:DESCRIPTIOH' t ..1 : ' N3. t a4 _;.?;
County
^ ^, Township Taring district(city,town,to hip) r _
Parcel Jnveyl FF6ec e,NItW��U U/IDI■Ovfi�egary/1J7 3/� s eery in questionn^I"'�IIlQ_/ly�
/Vv,LJ��x/ , / al properly ❑ Mobile Homo D.C.6-7-1-7)
if any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that stat,is used to produce income,describe the use and portion
of the property utilized to produce income.
C77(9 ./3 -<3i-a1d61 -Ol- .or 9-161di
.?5,szr.'��.'>_� e�xa=�Zrt`r't=k'-<PROP ERTX;OWNEDTBY CL'AIMANTIIJ.OTFIER`000NTIES" :'.-�,s.;� „aaing3atWrI(6P-M
County Township County Township
I hereby certify the above statements are true,correct and complete. \.7f//) /2P Signature of claimant,'/
�a �.
ss(number and street,city,state,ZIP code)
R•R./. Lox 305A FRANcisco , =,v '17 01?
r i 4�ASSES OR USE ONLY : r ,r TRUE TAX.�t! % 'ASSESSED VALUE HOMESTE ii " `+1 eNON 2ESIDENTIAi a i
�.iv4,.I -t z - , yy_ iy,.- ,�, r y31, +tVALUEZr. .ATa100%',OF Y, AVALUE � e.#�. SkVALUE ?�>S
Land not exceeding 1 (one)acre immediately ;9ahT "a f
surrounding residential improvements. (1) 4 ` ali
Other land (2) - Et
Trial land(line 1 plus line 2) (3)
Dwelling (4) 1tT,u .ireSS
Residential improvements or Annually •
��a y " "Assessed Mobile/Manufactured Home Garage (3) e:;.71-7;:s4-4-
Other improvements (6) ..`
Total improvements(line 4 through line 6) (7)
Trial value (line 3 pits line 7) (6)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
vt: iltt *'""rrk;� ,3 >'STANDARp.DEDUCTION ALLOWAIICE hs,,,ZW ;Me .s�-es's':.M;�s�,.f.Atglct
20—Pay 20
Lesser of 1/2 Homestead
$
eon or 535.000
Signatu $ 2Ner� r va Date sii1e/ 9 w V