Homestead_Smith (15) SOIL FORM')'M,a_)WO IAFANIna FORM:SIA
APPROVED IMPORTANT?NOTICE TOHOMESTEADFPROPERTYOWNERS 'a
Gibson County Auditor
101 N Main
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 eser for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1344-2009 requires taypayers who receive the homestead standard deduction to verily that they are 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 Amt confidential and can only he accessed by authorized county officials.The Depannient 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
Smith, Sammy John/Betty Jo
806 Tretter Park DR
Fort Branch IN 47648
7704
Sammy John/Betty Jo Smith
806 Tretter Park Dr State Parcel Number Legal Description
Fort Branch IN 47648-1224
Itlrrllt�t��ttt�tt��tt�rttt��rr�t�tt�t�r�t r���tt tt��rtt��tt� 26-19-18-302-000.732-026 011-00732-0OTRETTER PARK 13
t r
PART 2: TAXPAYER INFORMATION
Owner I • First Middle Last
SAMrnY J c, H_IN) \3 ed 1 1 N
g Address(number and street,city,state,and ZIP code) I- Same as property addreis - - - - -
306 1' R TE PARK OR ) V5 Fo 2RANCN ITN . y7 (,ci
Spouse First Middle Last
13 • 4_1 o Sm STN
Mailing Address(Number and street,city.state.and ZIP code) Same as property address
806 7-RETTER Pnrik1)RI F R-r 8RANcN ,-w. Lj '7b1
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
•
74 R•� � CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
'� •. J State Form 5473 (RS / 70-0i)
Prescribed by the Depanment of Local Govemment Finance
INSTRUCTIONS: See reverse side loi filing insfructions.
"..�`�i'��`_'i..�c : ' :."`" v�.,3=�'�?'`';"':i°rt'�iut J ,�;'.;"CE TIFICATI STATEMENT.%..•..,r
I (WB)
I(We) occupied as our principal residence the follo ' e'bed real propeny for which a
FORM ^A YEAR
HC10 ,
�� ��� � �
20_
daimed:
❑ I(VJe) owned ❑ Are buying under coniract
�1ave a benefidal interest in the enliry that is liable for ihe property tazes on the property and that owns the property or is buying under a contract.
t�. . -s� 3� r�,5sa.�C� �.t.�'�.�aju.�`".�.sCxs�•�_'i..i� °��'i.+2•4:�i5•t•i-eCONTRACT!RECORDED�?a� �� d,.�. fe ��FNu � . r 3 �' .Fa i . '-_ s ;
�r.-.W H - -�c.,_.. �,x �?* .�,:-Fs .. _H�� ,s �x--
il buying am m�Uaa, Fee Simple ownefs name
Recordefs office where wnVact is recorded Record number Page
County
V � l �V l.3d�U.
II any po�ion of IA8 residentlal sWdure w
of the O�operty utilized tn produce inwme.
Tavnship
T�cing district (ciry, rown, township)
descn����� I Is Ne properry in question:
❑ Real pmperty ❑ Mobile Homo Q.C. 6f.7-))
not exceeding one (1) ave mat immeCiatety sunounds Ihat swaure is used Io produce income, describe the use antl ponion
`y � —�- `�`''� � -fi°%� '` 3`�sr;� �.'�g�i�+ ,TRUETAX�' � y� ASSESSED VALUE � HOMESTEAD`� �-M NON-RESIDENTIAL Y �-
-�L���ASSESSOR-USE ONLY �r� � .� t � o t -� �� - .�, h A,�jri.-�VALUE� a;r� `:�`
x�,�.�v�'`r't,�-��.�a �*x ��*,Y.�'-,'��2.'...:,.�a`"r�.^:�„ro;,4°�'.�'�`, fai� VALUEy�,3 ,AT-100%OF�.m�..rt-.,..VALUE„��'.�`.. � _.-.—i:� F-.te.t.
Land nol exceeding 1(one) acre immediatety (� i` s� ��7� -�+��-*_F' i�'���
surrounding residential improvements. � ��"�i`',,.�ykk44,. },,, ; r�`-..(.��.�-
3 t+' � t(''y V�;
�+'
Otherland � (p) a� :��, cy,`�c
Tdal land (line 7 plus line 2) (g�
m � �.F""",.�s _ -'�
Dwelling (4) 5� :�� r;£„�� `a;., '�i.�,..
Residen6alimprovements '�p —�"r�-���'''��'3�'s
1 F..:.��.. �-.
Garage (5) .V�S�I^�'�y ��"� k:.�„N,�.
�Y ���+' J'.; �i ( �iih� A�.
�:t'iiM.f`A" ".uF+:�
Other improvements (6) = -„Y�f,.�,`-��
Tdal improvements (line 4 through line 6) (7) -
Tdal value (line 3 phs line n (8)
I hereby certify the above is We, correct, and Signamre of Assessor Date signed
complete.
Verifyi�g action - SignaWre oflwditor Date signed
�i.:.��:a�wiT�,��_,-�`�it`�`'s'�'�.'�K-`�'a-��.aSTANDARD':DEOUCTIONALLOWANCE .a"v�.�=L�Sf�3�'�'��� -;:`_�""P`•' � `3` '.
`�-`��'�'#: �i�. _.._.f �.va : �;Y ..+c, .':
20 _ Pay 20 _
Lesser of tf2 Homestead
Valualion or 56,000 S
Signature of Auditw Date signetl