Homestead_Summers •
STATE FORM 1110(Rl I blt7 TREkStRER FOLM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.Mg PRESCRIBED BY THE DEPARTMENT OF IOCALGOVI(NMENT FINANCE IC 6-I.I-12ti
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N.Main Street Individuals and married couples are limited to one homestead standard deduction. As the receipt of this deduction becomes
Princeton,IN 47670 more beneficial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore,
ILEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify 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 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
Taxpayer Name Location Address
Summers, Eric C
. 297 E.795 S/APACHE DRIVE
FORT BRANCH IN 47648
8155 1 1
Eric C Summers - IH III��III�II I��III�II II[Ill I II II 11111111 rnhI11 II_I�I�II�II hIII_II
297E 795 S
Fort Branch IN 47648-8008
�I��I�IIIIF�i�ltlllilii�lliillilli�lE���I�ttl�FElltl'ItlFllltlitl State Parcel Number Legal Description
26-19-19-204-001.331-026ZNDIANVS
MAY 9 2011
This form MUST be returned to County Auditor's 8I&6Qli?OUNTY AUDITOR
Please do NOT send this-form back with your tax payment to the county treasurer.
PAR;l2 TAXPAYER 1NFORN1AT1O\ --
Os.. First Middle Lasi
Mailing Address(number and street,city,state,and ZIP code) ❑ Same as property address
99 / C.- 145 5- Fora- (Jranck. In! L176wg
"
Spouse. First Middle Last
Mailing Address(Number and street,city,state,and ZIP code) Same as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
1 1 1 I l l l I sme
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 HOMESTEAD PROPERTY TAX
CREDRlSTANDARD DEDUCTION
sm� r� ssre cR� i sa�
P�esvbed by Ihe Depertrrent af Laal Goaam�eN Franoe
iNSrnucnavs: s� �e� s;ea � m�y;�s�ao,u.
1 �' } E �
�' � :� '.i .
FEB � 1 2008
� n^'e� CLLS�... C►_�1( �ld�Jl�'\A.LIa. �r �t @0tl5d�i @tit9NM�l1�Qg
I(We) occupied as av prmdpal plaoe of residence the fotlowing desaibed real property far which a Hm�es�ad Pmperty Tmc C�t is hereby daimed:
�� � M�e) owr�ed ❑ Me buying unAer cantrad
� Have a benefidal inferest m the entity Nat is liade Gw C�e pvperry taxes m Uie property and that o�ms the properry w is Wying under a cantracl
. . . . . . � CON7RACT��.RECORDm..;� ' ;tf" h'� 'S :�;. �. '.> i.,...�.7:•.
� M G+Y'n9 on mibact. Fee Sinple oMrnafs rertie -
f�mrdde ot6ce whae cmfrad'u recaded Recad numbe, Page
.. i.
Ca�nry
Twrddp
��t��T _C_` ��1�, � i,['` ��ega� pnmi. Is the praperry in p�don:
l�i i7 � T!1"4�6�� ❑� P�P�Y ❑ Mabik Hort�e (I.C. 61. f-7)
H arry portion dthe resde�aial stucWre w the lad na1 m�oeedng one (1) aae tlmt inmedafely eirtda� tlial ffiumre is usetl m pomca'sM.oma. desxbe IM ime eM portion
d the praperty u6f�d to piodce eimne.
,
�.�,F(�-9a��
_.� ; , , . : • , �eoaQrn ownm sr cworra►ar a on�ei couNi�s= s°
cwo ;s<tx;Y. �.w' .,.r,;: t.��.,: �';
County Tornahip Counly Tawnship
I hefEby Oefhly thC 26ov8 sfa�Efflglt5 2�8 WB. COrtBd azM COrtIpIC�. � .
{nlnbef mla s6eeC ery% sfab. ZIP CaOe)
m�
a4� E_ �745 r+ t. nl N"7t�N
- � +. �. .. , �y<r�, TRUE�TAX ASSESSmVALUE .FiO1�STEAD�.. �r'+�NON�fi�Ft�
+� � ASSFSS�tU3EONLY `. � T t ,,.'.� ,VAL.UE.F . �� 'AT,100XOFTTV t�` � VAUIE s -� �s�nt'c'1 �-VALUE ` � �t3��
,. ..r.�� ,�, ..�„� ..r.'�. .xu. ,s.:
t.mw rwc e�ny 7(one) ave imr�edately () .�zh �{y s�`a�"� r� i�`'��t�;i,�,���
SIOIOUlIdRigfC5id2flfi31iTpfOV¢fflG'fi�s- � .r Nw .rA"'�i:^. �S'F3 rnFl��23''Cs�.NI
Otl�erlard ��; s.`i�i���;,:.'.i; .
�Z) � � � 't.%!f.4�,;i14:rA%
Td� lard (1"cre 1 pkrs frre � i31
s,y c.�{�1y�4�fi'^ *er.� ' pF
�W@�i 4 ay'yt `'�%t"3',3��� �x i� `I%tY �'i11�t
Resdential"v�rvvertientsorMrwelly �8 ( ) �.xszj",'sna..•x ��s.ii'�-^:.F{R'�6��31
A�ssed Ab6de / AAarpAech+ed Flartie ' 4�T � i �' r" -' r+.. z-{.:
G2�e 5 ` �'�1,xx ,�y`�" r�3T,Y`t�' d'�'� y'}�}0q���
i) ,�a>.i:A xY"�•v.�_.��v. t. }, w`' 4..s"f �H`,.
Othe7'unpfovaf�ents (8) � .'���.�.���.
Tdal'vnprovements (iare 4 Wot� 6ne 6) �7�
Tdal value (16re 3 pds 6ne � (g)
I he�eby oer6y ihe abwe rs true. cortect. eM sigremae otnsscssar oate sip�ed
cotnplete.
VaiM�B ectim - S�pahae af ad'imr Dam sp�ed
� � . . � �.; STfWDAIm DEDUCTION�ALL'OWIINCE �;• i..;(J� r.. , r; -' ;'ein" ti':,i'z,�'�`a_..ti:,yae� ty�_ °�.+N
20_Pay20_
Lesser of 12 Homestead
Vaivation w f35.00o E
Si�atae of Puditu � �