Homestead_Johnson •
SLATE FORM.)e•lR:r tun TREASURER FOR' 75-IA
APrWwtD°,STATEmMRD OFM'n LNR.±nw PRrS[mBFD BY Till'DEPARTMENT OF LQTLIXWERNMENT FINANCE IC l!-r-r.I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples arc limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ever for homestead fraud.Ilonnestead 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 identifying information necessary to allow county^_oremment to better monitor homestead
filings.This information will be kept mnlidemial and can only be accessed by authorized county officials.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
FILE ]) Taxpayer Name Property Address
Johnson, Brantley W/Wendy L
407 S Cumberland
APR 7 'CM Fon Branch IN 47675
2596 �i
Brantley W Johnson p 2l?4z
407 S Cumberland St nio, N COUNTY AUDITOR State Parcel Number Legal Description
FORT BRANCH IN 47648,-7529
26-18-24-202-000.523-026 011-00523-00 LAGRANGE ENLG 217PT
Ir lnllt' I'II'u11111 uullJFlnnIJInJIIu111B11r lnl
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
dra.n1-lev If\(a�ne., JOhn5cn
.g Address(number and st&t city,state,and ZIP code) 3. me as property address
4B1 S. Gmbffland Ford- Qrafich , 141
Spouse f;� Lynn Middle .fro h n5� Last
�n
�. du e lvl�l
Mailing Address(Number S street,city,state,and ZIP code) Warne as property address
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
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
` ' State Fortn 5473 (RB ! 7-07)
Prescnbed by Ihe DepanmeM of Local Govemmenl Finance
INSTRUCTIONS: See ieverse side /or filing instrucfions.
�pied as'our prindpal pla r dence tlie 1
owned ❑ Pre u' o under contrad
FORM YEAR
H 10
�
' ' certify Nat oii�(he'tht daq 0' arch, 20_
property for which a Homestea��e�y���C�(qd�t i��Riaimed:
a berreficial interest in the entity thal is liable for the property tazes on the property and that owns the property or is buying under a crnhad.
If buy"vig om m�irect, Fae Simple wmafa imme
cantraa is recorded
counry
Pa�cel number
Twnship
It arry porlion of ihe residerNal sVUCWre w Ih`e Wnh rid eeduig o cr
dihe property uUGz� b pmduce inmme.
°��- /�-o?�j-ada-OOo,
Tadng
Is
Recdd number � Pag¢
� property ❑ Mobile Home (IC 67.1-7)
Ihal re is used to produce incame, tlescribe Ihe use and port'an
�a.� oa �
._ . . . .. . .
,, .
Land not ex�rg 1 (orre) aae immediately � � ' � � . - � . ��
surroundingresidentialimprovements. (�� � ,-_ '
Other land (Z) . . . .
Tdal land (line 1 plus line 2) (g�
Residential imprwemenLS orMnually ��irg (4) �� � - - - �
Assessed Mobile / Manufachired Home � .. . . . ..
Garage �5) . , • , .
.:;.r;-,. .
Oiher improvements (6) .
Tdal improvements (/ine 4 fhrough line 6) �7�
Tdal value (line 3 plis line n �g�
I 11e2by terti(y the above i5 We, correCl, and Signawre of Assessw Date signed (month, Cay, yea�
canplete.
v�ry��,q aam - sqnawre ora,a�� oa�e s�q�ee ��m. ear. rea�
..-.. . • •
�Y Z� — 45,000 for 2007 pay 2008 42,000 for 2010 pay 2071
Lesser of 12 qq.ppp for 2008 pay 2009 41.000 for 2017
Homestead Valuation paY 2�� 2 S
« 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature dAUdiwr Date signetl (rtronfh, daY. Yea�