Homestead_Allen StMtt Font 53,1.0L:I I-?O TREASULFA Po0.V f-IA
APFRIT'Et BY%DATE BOARD Or AXCTRI\\TS.yv PR6CRIBm BY mF oFPMnNEYccr LOCAL GOVERYMT't MA CE teli-1.1-r4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couple\are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than e'er for homestead fraud.Ilomestead fraud causes higher tax bills for all:therefore.
ill AEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recehe the
benefit and to provide additional identifyin_ information necessary to allow county government to better monitor homestead
filings.This information will he kept confidential and can only be accessed by authorized county officials.The Depanntent 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 Prnpem'kddress
—
Allen, Brad /Paurlaa G r��- (�, ,
iO I I �1 t v--) s s R3 BOX 8: — `� uu4`at9
Owensville I 47665
600
Brad E Allen
R3 Box 118 A- -(--P 1 ig :1/43.- •�S State Parcel Num ter Legal Description
•OWENSVILLE IN 47665-9171
26-11-30-100-004.290-021 005-04290-00 PT NW 30 2 11 4.25 AC
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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
rise 4.)3 ea Loarok cL i-`\Qn•
1 n1g Address(number�and gstreet,city,state,and ZIP code) t r [� Same as property address
V_\\G VD . &51J isS -h (argil et t,L ) • a J
'use First J Middle /`'�1 l Last
Ilkis
kok.Mailing Address(Number and Street.city,state,and ZIP code) l�e S`aamme ass property address C
_'----'— '
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 L //� Date
,
•
In
1 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Forth 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See rele'rs'?i side for filing inslnictions.
FORM YEAR
HC100
1L1� ��(/
�- ra
I (We) g1L 1r U \_/IKXX/ Vv /i certify that on the't•st day of March, 20
I (We) occupied as our principal place of residence the following described real property for which a Homestead.PFoperty Tax Credit is hereby claimed.
❑ I (We) owned ❑ Are buying under contract 0�BSON CO'! '4-Y AUDITOR
,'Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
���i�ii� .`'�.a�'1�•'�CONTRACT.; RECORDED
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
- '>"�':•` ��:�'T.rt' _�.�'�
��'-'� "`, 3". PROPERT. 1?. OESCRIP. TION�+'.' a5��✓, �.' �?' �.: F' � .;��s.�'�uL��os`c >- ��,.�� -6"_`-
Cou
Township
Taring district (city, town, township)
Par number
Legal description
Is the property in q lion:
property'
'TRUE TAX
'
p l o-, r
ASSESSEDVALUE
❑ Mobile Homo (I.C. 61.1 -7)
If any portion of the residential structure or the Land not exceeding one (1) acre that immediately surrounds that structure Is used to produce income• describe the use and portion
of the property utilized to produce income.
o?L - //- 3o -loci
'�VALIIE
Signature of Audhor
20 _ Pay 20
Lesser of 112 Homestead
Valuation or E35.000
County
Township
County Township
hereby certify the above statements are We, correct and complete.
S" re o claiman
Ad�ac�(nu ber and stneaLritz state, ZIP F.I. l _
!%
r °`-i: .x�m'• -,z'T .a'�:s Y1" __n
- }/ASSESSOR�USE ONLY
'TRUE TAX
'
p l o-, r
ASSESSEDVALUE
ai HOMESTEADS
t 9
NON = RESIDENTIAL
�s�-3
e-
F,'3�"'8•3y
'�VALIIE
ATz700Ya OFTTV -,x
.i.. <VALUE.3'`.
w`3.s.V.ALUE
Land not exceeding 1 (one) acre immediately
(f)
= "n, s `F;'"x0~�' '" -•4
4k ''°�-
surrounding residential improvements.
•�t''�"''
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
f,C'vr�w. °.,,craax_
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
()
•,a.. ''
"^ + "Y �✓; c,-
Other improvements
(6).y0y
Trial improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(6)
I hereby certify the above is We, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
Signature of Audhor
20 _ Pay 20
Lesser of 112 Homestead
Valuation or E35.000