Homestead_McKimmy (3) •
STATL FOAM!"MI R' TI1.1SU&FR FORM CIA
verMw'Fn BY STATE aMRn OF Arr.a,ests.brr PRESCRIBED BY OW DFPMTMEMTOf LOCAL GOVERNMENT mew\'Crte Vl.l-r4.t
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 IndividuaLs and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than tier for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
tt4LED HEA 1344-3009 requires taxpayers who receive the homestead standard deduction to verily that they are elicible to receive the
benefit and to provide additional identifying ece information homestead
to allow county government to better rnbnnor homestead
filings.This information will be kepi cord:demial and can only he accessed by authorized county officials_The Depanntem of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
LU10 PART 1: PROPERTY INFORMATION
APR 1 3 Taxpayer Name Property Address
,/ McKimmy,Anthony ULinda Marie
�sC/�, 800 Creek DR
GIBSON COUNTY AUDITOR Fort Branch IN 17008
2800
Anthony L McKimmy
800 Creek Dr State Parcel Number Legal Description
FORT BRANCH IN 47648-9500
II I 'I I 'I ( I I I I �I II 'I II I II 26-1918-101-001.167-026 11-01167-00 LITTLE YORK VIL PHASE II
t o ut t ut n u t t nr 1 1 ut nr ut ur nr 38 D-27
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
A C
l N D M t4-4-1 �- /s'y. l i.4\/n-Li
Gina Address(number and stray.city,state,and ZIP code) Same as property address
6)O0 Gts,2 Dr t f B , A, 47c.t
Spouse First Middle Last
Mailing,Address(Number and street,city,state,and ZIP code) ❑ Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
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
CLAIM FOR HOAAESTEAO PROPERTY TAX
CREDIT/STANDARD DEDUCTION
SteM Form 5�73 (R6 l �-IXi)
Presaibed by the DeDertment d Locel Govemment Finance
INSTRUCTiONS: See iawraa dda b�rp ia6uctions.
J
FORM YEAR
HC10
FILED
I(We) Y'— (/ C.L /�— certi(y ihal on the 1st day of March, 20_
I(We) occupied as our princi I place of residence the following desuibed real property r hi a Homestead Prog�T�c �� hereby daimed:
❑ I(We) owned ❑ e buying under contract GIBSON COUNTY AUDITOR
' Have a benefidal interest in ihe enfity that is liable for the property taxes on �he property and Mat owns the property or is buying under a contraG.
II buying on conVad, Fee Simple ownets name
Recorders ofica whera cwiVacl is remrdeA
County
Tamship
If any portion of Ne resitlentiel sW qure w the land not
ot Ihe properry ulilized b praduce income.
County
�� I Is the
one (1) �aa/e� that immedia�tety w—rrounds that
/ �lf�+'.�r�
Couniy
I hereby certify the above statemenls are W e, correG and complete. I Signature
and shg�t, cifjr, state,
Rewrd number � Page
iqueslion:
Rea� propeM ❑ Mobile Homo (/.C. 61.7-n
is used W produce income, descrihe the uu and poNon
� �. �r'�k'-.,�"=`Y"a�;�'i�"��'r..J: � i"'° xr-,�. . . ^r ' , � . u� �•�.
.''�, AS5ESSOR�IISE ONLY �� t TRUETAXg� �ASSESSED�VALUE �HOMESTEAD'� FNON�tES�DENTIAL �n
.'-�'�'�'�.F`�c� ��.�=r.9aa� C�r.�r,.e�..._.#K����?�'�3�..VALUEy�'s4„9 �AT�700%O q,TN-,� n�VAUIE,�� �y�' �-�:1' VALUE,�y44, a�;� p�,
Land not exceeding 1(one) aae immediatey � 4'��+K2�-�;'�'�..,���a ,��
surroundingresidentiallmprovemenLs. - �) `�� ,zt�'a�P�����,.j���;
Oiher land �2) ������'��.^�,�n*� •
-o-.;....�� .
Tdal land (line 7 plus line 2) (3�
� ...i.� �3 �-.. F ..
*u 4' :r=;' �irY� �-ti���
Dwelling (4) ��,s�.�'����'�*:R
�Residential improvemenis a MnuaOy �,� `
Msaffied Mo60e / Manufeaurad Hartie Gara e '.� �-�' � �: r�g ,a�.�
9 (5� � ' �� . � '.�+
xc�t�i:_ 's'a�` .t �
��� .��g
O�her improvements (6) �.�; �
�-:..s'-+"" � e.. s
Tcial improvements ((ine 4 through line 6) (7)
Tctal value (line 3 plts line � (g� �
I hereby ceAify the above is W e, corred, and Signature olAssessor oate siqnee
oomplete.
Vrrilying actrm - SynaNre ofiWaimr Date signed
•'�'-s'?ar�i�-<i�;z sN'�='�;°.�'��*..�ts��°��STANDARU'.DEDUCTION`ALIOWANCE,a_'�`�{'"9c-`" ' �` +- "�('��r{�Y� +�yr.,
� .. _ - a..�:�A^f �'i�_ �.t�u's.�i sr.i*s: i�i'�i'TrC�:`Y?/.'�..A'�a�s -���i2
20 _ Pay 20 _
Lesser of 1/2 Homestead $
vauaton or f35.000
SignaNre of AuQrtw ' Dale signed