Homestead_Mounts (3) SSAIE fnft•f",R:/'AP.) MASUUER FORM 79-1A
ArrRrr:ED BY'Skit HWDDf.NVfI.\'IS.N" PRISCRIBEDBY TIM DEMAR1\IEYr IR LOCAL CMwEEt4Mn'T rP:ANCEM6-I.!-r4I
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homesaead .,aandard deduction.As the receipt of this deduction becomes
*FILE t more 1344-200 there r mare iyers wh rec iver her homdtead fraud.lbmestead uctio ftoov rify th higher tae bills for all:therefore.
q ° HEA lilt-3009 rcpu'ves taspasen v'ho r•ccivc the hanestcaJ Aandard deduction to rrifY thlt they'are eliiWe to rccenc the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.'Ibis information will he kepi canfdenlial and can only be accessed by authorized county officials.The Department of
I.ocal Government finance will use this information to create tools that will help count'officials eliminate homestead fraud.
APR 2 3 ZU1U PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
, Mounts, Mark R �S---GIBSON COUNTY AUDITOR RI Box 265
Fon Branch IN 47648
Mark R Mounts
R1 Box 265 State Parcel Number Lethal Description
FORT BRANCH IN 47648-8020
II I1111111I11111111111111111r I111 I III 11111111111 1 26-19-19-203-001.271-026/D 2782-00 INDIAN HILLS 2
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PART 2: TAXPAYER INFORMATION
Owner I First Middle Last
/vIHRK Rici4AR. o /"lowv 5
�ng Address(number and street city,state,and ZIP code) — Some as propeity oddrest---— -
i36 EAST 8 00 Sou RI FT. QfANCH I/V 1174119
Spouse First Middle Last
Mailing Address(Number and street,city,stale,and"LIP code) 0 Same as propene address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
sae
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
( )
PART 4:ADDITIONAL INFORMATION
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4� R� , CLAIM FOR HOMESTEAD PROPERTY TAX FORM Y AR _�
� � CREDIT/STANDARD DEDUCTION HCto � (�i b 3 i
` J Sute Form 5473 (RS / 70-0t)
�O� Prescribed by Ihe Department of Local Govemment Finance
�
INSTRUCTIONS: See reverse side for liling insfructions.
y�;j�.`�y�._� ^'- a '�:._ :. - `�`��' -� - :�CE TIFICATION-STATEMENT-�.:. � .
I(We) certify Iha^t bdth�i94 dGpO�arch, 20_
I(We upied as our principal place o residence the following described real property for which a Homes ad Property Tac Credit is hereby daimed:
I(We) owned ❑ Are buying under conirad J
�lave a benefidal interest in the eniity that is liable for the proPerty taxes on ihe property and that o ns IFie��is�lft�Giljt3JilryirtQ��, � aoniract.
116uying om m�trad, Fee Simple ownefs name
Remrders olfica where contract is recorded Rewrd number Page
�s::<"�c"_�.�F�'�4..'; .;;...:.o-.-`-���rrvrrn�.?`.':�.s.a�Y:s.,..� �=FROPERIY.UESCRIP.TION`�-= � ..:i:�F� r �; �< �. �:x4 -
>> �_... -
County Tamship Tacing district 'p own, township)
description I Is the property in questi :
C�perty ❑ Mobile Homo p.G bi.1-7)
if any poAion af ihe resi0ential sWGure or �he Wnd not exceeding one (1) aue that immedia�ely surmunds tha� swUure is used lo produce inmme, desaihe Ne use and portion
of the property utili2ed b produca income.
I hereby certi(y the above statements are We, wrrect and wmplete.
(number arM Streef, city, sfafe, ZlPCOde)
��`-Gy'A;�.� '�T'°�=`"y''�'��"'�'�> �v� R-''i.� �'TRUETAX , �ASSESSEDVALUE -HOMESTEAD-+ r3NON-RESIDENTIAL`' y��-�
�+���,�'f.��A5SES50R�USEONLYa� '}g�;��y;� VALUE;. �i.�.:AT:100%OF�T7V' c,,,XVALUE�t�? ����.t_`:.'VALUE.-y���,�i�
Land not exceeding 1(one) acre immedialely yslt �" �� -*`"'��: �"''; �'����_
>.ti' ''': .e
surroundingresidentialimprovements. (�) �T �`.:,;'ykr4#,g.,.�_,�;�;_i„��i�;
�,"
Otherland `��p��p s `k �
(Z) n .�4'.�:. � ���
.i-rc.>
Total land (line 1 plus line 2) (3)
�.. a�s `t��`jc s�'�xc ��Fx�syA' * t'
Dwellin9 (4) 3 y y ���y.,��=?7'`�rr.a� �i.''�.s�.ri"4
Residential improvements � .
4"-�'t�i; r� 's`+k�� F-i� .
Garage �S) 3g' � v +i',�'"'��'�i_�^ '''??�.
r�
.;.. �.,�.�..,�. �-�d'.,,ht
Other improvements (6) '�`' t: q + .���;
•i.�'. _,..
Tctal improvements (line 4 through line 6) �7)
Tdal value (line 3 phs line n (8)
I hereby certify Uie above is We, corteG, and Signature of assessor Date signed
complete.
Verifying action - Signawre ofNitlitor Date syned