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Homestead_EllermantUilll fUi( IIU'1�IUU rlcUi'Cf;II IIV 1�Url Ivl` iuu 11G1i1 i SEE BACK FOR FILING INSTRUCTIONS certify that on ie 1st day c r'trch, 19 I, ('r)e) ed our principal place, or follcming described real i nm° °ty for � -d ch a I1mrr.astea3 Prepe..rty Tax Credit is hereby being clai>red: o /o- ooa''� . are'-bufinq urrler contract - Q have a beneficial interest in the tarpayer�g - Q� �- 4LI� O�� 1 rrocc r-ty Description in ��(� daullty 7 'lt�.m7,h i 't'-.• (City, Ta:n TowTsliip) : ng District Parcel Nmi= or legal description sl)aym on tax statamnt: If buying on contract: Owners n3n>° (fee simple crvmer) Contract recorded in Recorder's Office - Record 1b. Pape r if anry cor'Lion of the residential structure or the land, not emeeding one (1) acre that rr_diately su--T ands that st ucture is used to produce inane, describe tile . use grid cordon of -Lne pro�:erty utilized to produce incorre nn:r' other counties in which indiv dual arms or is buying real property: County Tmalsliio the above staton?nt is true, correct and con late. 7G I,LO cYraat z�iiress City, State and Zip Ccu'.i I k:LLL:.0 *Individual eiUn - -r c,..,ms or is tmying caner a contract that provides he is to pay the pro =-ty taxes on the residence, or has a beneficial interest in.&e tarp3yer. - FOR ASSESSOR `S USE ONLY - True Cash Value Isy�l not e cee. =ng 1 (one) acre incrediately surrourrli.ng residential in�rove:,nnts Other Land Total .Land pesidential InprovENEnts Dwelling Garage Total (1) (2) (3) (4) (5) (G) Oi_ ^.- IIiu�. riS.'ETl °liS (7) — 'lr 111coroveitints - Line (G) plus (7) equals (8) (EI) I �re�V CeiirV the abo'v °_ 1S tSl1er COL72Ct., and CQ7ip1Et_. icnature of %Ssesscr - ACTIOH BY AUDITOR - Assesssi Valuation to Date: Glued - / Valuatic: U stArE FORM!)'Mla_/ANI TREASURER FORM r11A ArPROvEO BY RATE aI+ROOF Am1N13.Ox PANCRIBED BY nit DEPARMEfr OF LOCAL G\Ttt1rFr F ANCEic H.I-U-r.l Gibson County Auditor 101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS PRINC TR111 4, 670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes IgByl ,, H9H I more beneficial,there is more incentive than escr for homestead fraud homestead fraud causes higher tax bills for all:therefore. • 1t HEA 314-2009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to reeene 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©n only It accessed by authorized county officials_The Depanment of APR2 p ZUw Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud. PART 1: PROPERTY INFORMATION Taxpayer Name Prole Ellerman, Daniel J/Karen GIBSON COUNTY AUDITOR R I Box 48 Ilazleton IN 47640 272 Daniel J/Karen Ellerman 6977 N 25 E State Parcel Number Legal Description Hazleton IN 47640-9237 - Irlrtllrrririllrlllr111lrl1r1trrrIrlrrllrlt��rtl��ttr�r�rr�� 26-05-58-005-0000.218-018 010-00218-00 PT MD 5 1-10 8 AC rl 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 Nte.l , S g- l izivDrJ ng Address(number and street,city,state,and ZIP code) �1 Same as property address a `1`1 N 5 A z l��a►J T '476 Yo Spouse First Middle Last kPg-r i-► L '6te4artAn) Mailing Address(Number and street,city,state,and ZIP code) [JI Same as property address — - ------— _ - 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. Ow er I Signature Date '` PART 4:ADDITIONAL INFORMATION •