Homestead_Gray STATE FORM 5150(10I8-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,3L01 PRESCRIBE BY THE DFP.ARME•T OF LOCALGOTT.0.\MENT FO(A-'Z IC61.1-!6-1.1-22t1
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 causes 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 idanifying information necessary to allow county government to better monitor homestead
Local ove information Finance will kept this information and can c onW be accessed that will authorized county officials.The mestead fro of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
I J PART 1: PROPERTY INFOILNLITION
Taxpayer Name Location Address
F a s ^,� Gray, Connie
302 N Main
(v\ v\ Fort Branch IN 47648
C gg9N COUNTY AUDITOR
Connie Gray I- 1111.11 I[_Milli 111111111111111111111 I III 1111 IIIIIilIIIIIIInIIIIIIICIIIIII 11-
302 N Main '
Fort Branch IN 47648-1003
1I'I"I'I'll'III'll'lllI'I' "IIIIIIIIIHIIIIIIIIII'I'I"IIII'II State Parcel Number Legal Description
26-18-13-402-000.381-026/ GENUNG&WALTERS 185PT/186PT
-. 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.
-- _..—_. _– _ ._-...__-_.EART2:TANPA]_ERINFOR:MAT!ON --___-, ,-�- - _
Middle _ - Last
�sn�r �e /t h /2 14 -
Mailing Address(numbs and street.city,state,and ZIP code) - 'Same as property address -
30 g5 At A'/Qlir Sf 7O/ / g-%a-17eAi1/.
=.
Spouse _ First Middle - Last
84 h 5"p/'d t o a / /�e lT P47 -
Mailing Address(Number and street,city,state,and ZIP code) - ❑ Same as property address .
3oa /V' Male sf: 42oi'tS(a„c,/ ,-ZW..
< - -
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 1 Signature Date
•
FOHA7 HL 10 1919 To Be FileG in Duplicate
Prescri0en By 9ate BwrG oi Ta. Cammissioners � �
CLAIM FOR HOMESTEAU PROPERTY TAX CREDIT FOR YEAR 19�
SEE BACK FOR FILING INSTRUCTION�/ �0 3�1� ��
'(We) 5��� Y ��°x��- c�fy that on the 1st day of
�Narch, t9 "7 9, ( e ccupied as ur principal place of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in ��•-a-+��-� County � Township
Taxing District (GiFy;-Town, Towrtsfirp): ��• ��-�-
Parcel Number or legal description shown on tax statement:
,� d- 7,c/a�.�"� / 8� PS�. 1$ ��
If buying on contract: Owners name �'� "'"o1e °^"e'�
Contract recorded in Recorders Office - Record
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
Any other counties in which individual owns or is buying real property: County Township
�hereby certify the above statement is true, correct and complete.
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land
Total La pp
Residentia lmp�verriEcNS �
r�4Y 3'•_ i979
True Cash
Value
(1) /�OlaO
(2) —
(3) /!o �oo
Dwelling �4� �
Garage �5> —��-�
Total �6� �'�a'�`'�
Other Im r en
Tr' ImP o e t� i�) equals (8)
I"�oy certi the a�ve �41�i�Rcorrect, and complete.
Signamre al Assesw�
(7) --
(8 ) '���
- ACTION BY AUDITOR -
Assessed
Valuation
S� o
��o 0
�76f�'
Homestead
Valuation
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