Homestead_Hollis (3) ST■1E FORM'M Ill'/.-4.1 �tNASDaER FORM SIA
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Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N Main
-__ PRINCETON IN 47670 Individual..and flurried couples are limited to ore homestead standard deduction.As the receipt of this deduction becomes
di,
more beneficial,there is more incentive than ner for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2009 requires taxpayer>who receive the homestead standard deduction to verity that they are eligible to recebe the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing.This information will he kepi confidential and can only he accessed by authorised enmity officials.The Depanment of ,\
Local Government Finance sv ill use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Hollis,John R/Stephanie S J
R I Box 254 cCs12•-/
Fort Branch IN 47648
- 7963- — - - - - — — - - - — -- - - —
John R/Stephanie S Hollis
176E 795 S State Parcel Number Legal Description
Fort Branch IN 47648-8007
26-19-19-203-001.258-026 07-00722-00 INDIAN HILLS 18
t o II nt It II nt I n II leI r I itIt II taII nt'nt II nt't I I nn IIt I D-27
PART 2: TAXPAYER INFORMATION -
Owner I First Middle Last
Joky — Rau bid/its
---�ng Address(number and street,city,state,and ZIP code) — - EiSamc as property address ---— — —
1 % E. 7 q5 S; pt. Bra'rnGL / 1 Ai 4 76.Ver
Spouse First Middle Last
Sflt/ho-ni _ .5-Ifepkens /Jo«i s
Mailing Address(Number and street,city,stale.and ZIP code) 177.Ssme as pmpenv address
174 F, '745 Pt, ate- J -zit) g7tra
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 Signature Date
k
CLAIM FOR HOMESTEAD PROPERTYTAX
CREDR/STANDARD DEDUCTiON
sm�e rv� s�rs cR� i so�
Praffibad by tlie De�mtrrsrt d Loml Gorarmad Franm
INSTRUCTIONS: See raverse side Ior Ring instructrons.
FORM
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i�we� i v �� �ersry n,ac o� me �� eay or �, zo_
I(We) pied as ae prmdpal placE rrsidence ihe fo6owirg descnbed real p�operty (a which a Homes�pe�7%(�Gedt is hereby daimed:
� I owned ❑ Me buy'vig unda fmtrafY v
GIBSON COUN7Y AUDITOR
Have a benefidal c�Fare4 in fhe entiy ihat is liade br the poperty �ces m the propeM1y arW tl�at owns C�e propeAy or is Wying under a contracl
tt buyig m mrtre� Fee Sirtqle a..�efs rvmB
F�cudds d6ce where wUect u rewded
� si .
Camy Ta�rtchip
Rewd numher I Pepe
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Is the papary in q�fim:
❑ Real poperry ❑ Ma6ib Fbnie (LC. 61.1-n
M erry portion of fM resderaial st�ie aI tha laitl nal mccee6np one (1) aoe tlmt inrte6alely amaa� tlul cMrL�a ia used Oo pmtlice nmma. dmu3a Ihe �me aM pvtion
d tlre popeM1y uli�d b produce'n�mrre.
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`�?. .�� ASS6SORUSEONLY � ���`"��, :``'TiLJETAX ` ASSESSEDVALUE -YF10�STEAD�`� `. �,9 MON�IiIAL'��y��"�#�
'".4t;:' "s x.. 5��. - afi r- azy-i.. i V/LLUE.:� AT 100X OF�TTVy r�� �YALUE � r: - �3fi,y R�u.4 VALUE �t-. +�3 ��{=..
Land not exceedng t(one) aae irtrredia�ly_� (1) �� �s 3��,� t.,�a'K�d�'l��s� 7�;�5'J, �
�d�9 �� ������- "v.� �aA.-�..r�. ,t!' en�.�%; ro!
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� 'In �� �i r ��� � p i '� .7�i#ha��•
Residential"vnprove�i'ieirisorMrwally Dwe6rg (4) y�xt,�'�^•'��.�3`d�y'�P"3�t{��'.�'i-f,stm..�'.-`.�y��i
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Q�}18i QIIP(OVC1i1P•f1i5 �b`� �_..••t�e s1':'..
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Tdal ur�provernerrts (fare � Wougdi 6ne 6) i7�
Tdel value (1'are 3 pGs Gne � �g)
I hereby certi(y tl�e above s true. curect. and 56�� otAaa�vor Dam s'gied
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Vaifyug edion - Sipr�aNe W P�x6mr Oate signed
Y. y a � :._s :ti.:'e �.� \... �.:�.rSTANDARDD�UCT1011ALLOYIIAMCE nii=;lS. ..�i� .`itTF,�,.'�'�..:z` `tz4.;�x,r�;�?t?t:;!�t
20—PayNl—
Lesserof 1/2 Hortcstead
V�uatian or 535.000 S
Si�a6ue AMMiiditv Date s�ed