Homestead_Shade (3) STATE FORM SSSoCIRl IR-ta) TRFASCRFR FORMTS.IA
, APPROVED BY STATE BOARD OF ACCOUNTS,HM PRESCRIOIn BYTIIE DFPARTME\'T OF I(ICAI OOVERNMEYT FINANCE,Ica-1.1-n-t.1
Gibson County.Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY (OWNERS
Princeton,Main Street
P Individuals and married couples are limited,to one homestead standard deduction.As the receipt of this deduction becomes
eton, IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fmud 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
'0 o e rm
benefit and to provide additional identifying infoation necessary to allow county government to better monitor homestead
filings.This information will be kept confidential 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
it
Taxpayer Name Location Address
AUG 1 20�! Shade, Nichole
105 E Williams
' C. -n Fort Branch IN 47648 '
7027
GIBBON COUNTY AUDITOR IId10111dlll II I DIII VIII J III�II II_II Illll II 111111 III�I_II DIInIIllnlll II
Nichole Shade
- 105 E Williams .
FORT BRANCH IN 47648-1127
II'I'lllll'IIIIIIIIIII"III'III'II"1-1II'IIII"IIIIIII'I"'I'iIII State Parcel Number - Legal Description - ,
26-18-13-404-000.414-02r_GENUNG&WALTERS 177
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.
,� .___—_ _, __PARL2LTASPAYER I\FORNIATIO\_
Ow- t First Middle Last
4/1C.-149 II— A ;iv) QyKe-/s tic,d-e_
Mailing Address(number and street,city,state,and ZIP code) El-same as property address
10C 6 .Ul llf.4AS F+ 6vo,nCJ r,✓ Li7bcf 3
Spouse , , -' First , Middle Last
Sin hJooj ID\../ iCe._
r, Mailing Address(Number and street,city,state,and ZIP code) [same as property iddress , .
. -
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 .e liable for backktaxes and substantial financial penalties.„ '
Owner I Si ' Date
CLAIM FOR HOMESTEAD PROPERTY TAX FoRM 1'EAR
t CREDIT/STANDARD DEDUCTION HCto
� State Fwm 5473 (R6 /403)
Prescribed Dy Ne Department of Local Govemment Pinance
INSTRUCTIONS: See revcrsc sidc Io� lilinq insfnrc(ions.
I(We) � V/ G C- C � � certify.(dat oo-Hie 1sf day of Marc�1h, 20
I(We) occupied as our principal pia of residence Ihe following described real property for which a Homestead PropertyJT�Gre�itrs Q.�oy daimed:
� l) Y
❑ I(VJe) owned �re buying under contract //L7 �
, Have a benefidal interest in the en6ry that is liable for the property taxes on Ihe property and that owns the prpperty or is buy�ng dnder a c�UaclC
If buying on conuad. Fee Simple ownefs
Recorders oi6ce where conVact fs recorded
Caunry — TamshiP //
( JL
Parcel nu 6er L gal description
— O —Ob em,.xn�
Nany portion of Ne residential sWdure a the land not exceedi
ot Ne properry uL7izetl W produce income.
Record number � Page
7atin9 djytriet jtity, �yh, townsAiP)
i / 0.�.,
the v�operN in
_��pQ�--y� �7� yGnealOroperty ❑ Mo�IlaHwno(I.C.61.7-7)
(1) aae t�at immediatey wrrounds ihat swaure is used b produce income, describe Ne use antl portion
�.�.t.2` �'�' `Y`�') �.-�^��""C� �'F'``'�''-' '�;>`:STANDARD'.UEDUCTION'ALCOWANCE- wv^�e�".,"k�s .: . ^�r':�...c`,.. '.,y.,�_ - �
��-4Xi.,�.n�3C.ic4'��xR;_4'+i'.`.� � _ ��.�si��"k''...+. ��E+..�ie�¢"s: F
20_Pay20_
Lesser of 1/2 Homestead
vauaUOn w f35.000
S
SignaWreofAUdtor ' Datesgned .
