Homestead_Hartley • SIAM MVO`rt.tt I'aryl 1)FASUarl FORM:SIA
APPROVED LW SIsti.BOARD OF'en NTS.9.w PUS JBFO BY THE OrpAknnQVr OF LOCAL GOVERNMENT FINANCE IC4-Iy-R1
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD
101 N PROPERTY OWNERS Main ,
PRINCETON IN 47670 Individuals and married couples are limited to one homestead alandan7 deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ever for homestead fraud.homestead fraud causes higher tax bills for all:therefore.
HEA 1347-7009 requires taxpayers who receive the homestead standard deduction to verily that they are eligible to receive the
benefit and to provide additional identifying information rece.sary to allow county government to better monitor homestead
fling..This information will he kept conhdenrial and can only be accessed by authorized county officials.The Depanment of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMXTION
Taxpayer Name Property Address
Hartley, Shanna
___ _ PD e 302 911111 —'el
Somerville N 47683 VV((��
8408
Shanna Hartley
PO Box 252 State Parcel Number Legal Description
SOMERVILLE IN 47683-0252
26-20-02-201-001.896-001 MILLERS ADD 2PT/3/425PT26PT/27PT
t o II ncIr II n I n I ul II r II uru 11111111111111111errielillol
X
PART 2: TAXPAYER INFORMATION ..
Owner I First / Middle J(/ y1 Last
Skkings 114 t/ r("J L1•� ( ,T'•I
•tg Address(number and street,city,state,and ZIP code) r - LI Same as property address ,/'7 b--- - —— --
Boo N. L1n/ - I/t/ S4. PD �K. �S Z S.:Jervil/e 4-A4 'f /C, �7
Spouse First Middle Last
WONt
Mailing Address(Number and street,city,stale,and ZIP code) Same as pmpeny address
Social Security Number(last S digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
Slate
PART 3:CERTIFICATION
Each undersitmed certifies,under penalty of perjury,that the above and foregoing information is taste 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
bi- Tow Iva OF -M- S � Cr,A A4Ni O re.(1(-1 .t
tit ,14 re c< C:S Pc Br. 2c7 5",-. /-✓;l IC A Lilt. I
74-01•14i orrtn.. I elAtin'+r (,JOS Else A4 L-r✓4-4 1.✓ 5T v c $s,r .15.Z
c.,..t•Le h(ta ST.➢. 4'tc i
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R6/4-03)
Prescribed by the Department of Local Govemme.t Finance
INSTRUCTIONS: See reverse side for filing instructions.
f Lb 0 bf 2005
I
qa�
YEAR
C ER -FFJE)9kTl0N STATEMENT'
I (We) aM /I &Q
jt�[O.A) olif tT wch, 20
I (We) occupied as our principal place of residence the following described I property Property Tax Credit claimed:
❑ 1 (We) owned ❑ Are buying under contract
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.
'40 —
CONTRACT.RECORDED
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
P R 0 P E RT-Y.- O_ W N E D BY CLAIMANT I Ni 'OT H E R, 6 0 U N T1 ES
,''PROPERTY
DESCRIPTWI
- ti
Coon
County
Township
Ta nshiip
Tact i
(at ,town
ship)
t
Legal description
Is the property in question:
P
rbcr C)
r,3
ved'i
I ❑ Real property ❑ Mobile Home (I.C. 61.1-7)
If any portion of the residential structure W the land not exceeding one
(i) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
Total land (fine I plus line 2)
(3)
C4,0,
/-
P R 0 P E RT-Y.- O_ W N E D BY CLAIMANT I Ni 'OT H E R, 6 0 U N T1 ES
TRUE TAX
County
Township
County
VALUE
Ta nshiip
I hereby certify the above statements are true, correct and complete.
VALUE
C S t I
lure of c mant
surrounding residential improvements.
ess (number and street. city, state, ZIP code)
poy A,II &I
S� Lf
r,3
ved'i
el-A,11
(2)
20 _ Pay 20 _
Lesser of 112 Homestead
vFjuauon or 535.000
STANDARDMEDUCTION ALLOWANCE
S
Date sieved . I
TRUE TAX
ASSESSED . VALUE
..-HOMESTEAD.
--A
VALUE
AT 1000/.-OF-TTV-
VALUE"
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (fine I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
vFjuauon or 535.000
STANDARDMEDUCTION ALLOWANCE
S
Date sieved . I