Homestead_Martin (19) SLATE RAM LOA.SIAM WOAD INASUIEI r4AV S-tA
APPROVED BY SIAM IXxiaOMMtTL ix,±nx rlJt tU➢m BY lilt DEPARTMENT UfLOCAL C.n4RLN5tt57 FQ:A'cElc Vl.l-]:act
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead sundand deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than ewer for homestead fraud.I lomestead fraud causes higher tax bills for all:therefore.
HEA 1511-2009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will he kepi cool:dential and can only he 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 INFORMATION
• Taxpayer Name Property Address
Martin, Daniel E/Mary L `�
Ji.2 D,,.. 108 a
Fort Branch IN 47618
2489
Daniel E Martin
500 N Main St State Parcel Number Leal Description
FORT BRANCH IN 47648-1055
itlttlltttltlltttltrllttlttttlllittttltlttltltlltttllt rtlltttl 26-18-13-402-000.257-026 /011-00257-00 DOUGLASAOD 5/6/17/18
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
meanie/ ova n /II t717'n
fling Address(number and street,city,state,and ZIP code) I(,►Snme as property address
500 N Male , Ff . �Qanch •7N y-76L18 -loss 44Yfff
Spouse First Middle Last
/Wax/ )0 mice. �at'hi
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
500 41. Malt), Fozf Zj,(2r'cA 4' 476VP-los5
-- --- -- - --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
CREDITISTANDARD DEDUCTION
� State Fwm 5473 (RB / 4-03;
Presaibed by lhe Departmenl af locai Govemmen� Finance
INSTRUCTIONS: See revcrse side foi liling insfrucfions.
FORM YEAR
� �H�10 �
.�_ :$�/ .�1 ..
ucT z 3 Z003
� (Wel �� /C 0 0 ��� [ J i7 �� 7 / / 1� / /I(J .�'tt�at=ont :tst'd"ay�of�Maich..20/
P P P P 9 P P rtY •- Ib Pd,i� y e..., r. .�u�,r,cb�y �aimed
I(We) occu ied as our rinci al lace of residence the foll in descnbe real ro e for which a Homestead'Pro eA Tac Credit is ere
❑ I(We) owned ❑!ve buying under coniract
' Have a benefidal interesl in ihe enlity that is liable for the property taxes on ihe property and that owns the property or is buying under a wntract.
If buycg on canVacl, Fce Simple ownefs name
Remrders olfice whera conVaa is recorCeA Recard number Page
.'��''.,-`�'���'����`i����`�" `-�r��. :_��? PROPERT!f<UEBCRIPTIONS�'`.'.�;."�;?�'�f.���4�.���.'��''`-�',r���?°�ii
Co � Tawnship T � t(d . wn. (ownxhiP)
Parcel numher Legal desaiptbn Is the pfoperty � quesUon:
' —Q � Real property ❑ Mobile Homo (l.C. 61J-n .
H any poAion of the residentlat aW ctura w the land not exceeding ane (1) ace ihat immediatey wrrounds Nat struaure is used to produce income, describa Na use and portion
of the Dfopef�y uilGZed t0 pfodut8 illtOmO.
�'K��-� �? _���'���sTnNtiaan oeoucnoN�auownp�cer,����':��<���--�a�'�,.s�'�'�'�.�-.���
20 _ Pay 20 _
Lesser of 1!2 Homestead g
vewenon w 535.000
Sgnature of Auditw � Date signed