Homestead_Ashby STATE FORM 53569(0.1110) TREASURER 100.N7StA
APPROVED BY STATE BOARD OF wcouvrS,MR PRESCRIBED BY 111E DEPARTMENT OF LOCAL C,,OVERNMENT FINANCE MbL.I-na.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
Pflnceton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore,
F b rte t and t information will be kept confidential and can onh be accessed by author-zed county of5cials.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 •
APR 112011 Taxpayer Name ' Location Address
— C n`"w--" Ashby, Renee
t-\ 403 E Locust
GIBSON COUNTY AUDITOR Fon Branch IN 47648
2473 ,
Illmii:tinu10101thu 11111_1111i111111111 iII Ituiihi ii 2eneeAshby
403 E Locust St
FORT BRANCH IN 47648-1416
r1111'1'I'I'llll'1111"1'111'1111'IFIIIIIt11111111111'11'11"11 State Parcel Number / Legal Description
— — 26-19-18-303-000.168-026 �vf'ALTERS ADD 122 PT/123 PT
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.
�1 - PART 2: TAXPAYER INFORMATION - . - - �..
First Middle Last
MI
nee 0_ 1nrIS+ t1-e
Mailing Address(number and street,city.state,and ZIP code) 7 Same as property address
Spouse First - Middle Last
Dona\ 6_ (-2nc " `Ask b Li ST
Mailing Address(Number and street:city,state;and ZIP code) _ - - rysarnc as property addres> -- -— — -- --'
_.
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 : ; ,ture Date
CLAlM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
S�te Form 5473 (F27 � sa�
Aaffiibed by ttie DepaNient d Loml Gorermierd Frarwe
INSTRUCTIONS: See reverse side /or fil'mg instn�ctions.
FORM
HC70
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