Homestead_Agnew <1A1E FORM 53N.IIC'r'•t fRFASI:EEB FORM TS-IA
AP/Rion,BY MATE WARD OF ACTMNIS.gn PLF$TIBr BY fir DEPART6Yr OF LOCAL rovER.YNrn FINANCE IC 1.1.1-2_4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ner for hontestehd fraud.Homestead fraud causes higher lax hills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information nest:slry to allow county government to better monitor homestead
filings.This inforination will he Lett confidential and ran only be accessed by authorized county officials.The Department of
Local Government Finance will we this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Agnew, Orville D/Judy L
R21 1569
Haubstadt IN 47639
11011
Orville D Agnew
12378 S Brook Dr State Parcel Number Legal Description
HAUBSTADT IN 47639-8002
II III II I I I III II III II I II n I 26-23-16-100-002.041-024 004-02041-00 COUNTRY AYRE EST 2 Lot
t o ra t nn h u n t nl to ten 12 PT
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
OgIDLLE tWA Al • IEw
Ig Address(number and street city,state,and ZIP code) — -- 0 Sarre as property address ——
id37$ 5 k�Roo1(16 R. \AAk STAb1 ,=N Hi to 3Q
Spouse First Middle Last
uDy LyNN6 GNEW
Mailing Address(Number and street,city,state,and ZIP code) n Same as property address
/23'7$ S t32noM pR. \\AkC3STAIT SA/ H7(t3q
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 properly. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she ma• liable for b• t taxes and substantial financial penalties.
Owner I Signature _ 4e
�CLAIM FOR HOMESTEAD PROPERTY:TAX "..' �, . . .
CREDITISTANDARD DEDUGTION
♦ I Sm�c Fnrm S.t7� (k6 / b-03} •
PrescnbcA by the Department ol Local�Govemm�ni Financz - • ' '
INSTRUCTIONS: Sce �evasr. Sidc !nr /ilinr� irs)nu:lirins � � . - � �
M� FORM YEAR
HC10 � �
I(VJe) C/1X{� V /�Q.ft/ ce�rfify tha�on�f e 1st day of March, 20_
I(We) occupied as our principal place o( residence the foll "ng des �b d real property which a Homestead PropeqstT� ��bagereby Gaimed:
Nrrc
❑ I (We) owned ❑ Arebuying under conlracl � � � � -
1� Have a benefidal interesl in the entity that is liable for the property taxes on the property and Ihat owns the pmpe'jy�.pr is buapr�tmder a contract.
If byvig on conVad, Fee Simple owner's name
RemNers office whera conVad is recorded
Rewrd number
Page
Coun Ta�msltip Tating dislrict (city, fown, township) /-
(�..
Parce p�p'�) /�'� Legal dascription Is the property in uestion:
��/ ��L�7'�,`Q Re I praperty ❑ Mobila Homo (LC. 67.14�
If any pCf.larC1 Lhe resjden481 5W tWre Of N8 Idnd noi e%Ceetling ona (i ) 2ae Itlal immeCialely SUrtountl5 Iha swcture is used b produce income, describe the uu and portbn
of the property uNzed to produce inmma. . �
—�.���/� �/�'/7/
County I Tv.vns�ip
i hereby certify the above statements are We, conect and comp�ete.
�dj:,=ss (number and sfraet. ciy, s1@te, ZIP code), ' , �
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�
■�
■G���
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TwvnShip
:.: i.
2i ' � P +�V� 9 �F1S'^i'SN.iti� �" L � ���4✓s i �y-i ( _ � _ ' �. Y H ,h .
���s������SSOR,�USEONLYr`�yv�`���n-`�' -�TVAI:UE ��'�- AAT1 OYeOFTTV,� ��.VALUE�3.�r'�'����„ON VALUENTI�L�f� j
Land not exceeding 1(one) acre immediatety �„�,n� q.�� uF�FT` t-�Yw�e�;
surrounding residantial improvements. � (� � 'r" '��� �` i,� � ` iYt' � ��
..�iT . } F Cr l �y 1
�¢=vr:n;r.: •
''t�'�h��� v2„-'i^
Other land � � (2) :t,-., {};ra�r_���
.;e�: s�
Total land (line 7 plus line � (g)
Dwelli^9 . (4) . � r � �v�t i � u°Y� i' �4l � -i'
.r'" •�'� �`�'+..�ev K.YSs S L`5
RasidentielimprovementsoiMnualy y �,�..y�,,, ,} _ �,� T
Assessed Mobile / Mamifactured Home Garage (5) �' r}�-'>�'�c``r�'� s�-£+y�.�_ s�a?'.
t,,,�,r ...�e: �� ����-4-. .. �:Iis:z i
Other improvements . � (6) �t � � Y. �
; ,.�. �4.rt _
G S.i�aG y:F-! _y
/� ]'. -w..`lA
Ta[al improvements (llne 4 through line 6) (7)
Tdal value (line 3 plus line n (g�
I hereby certify ihe above is Uue, corred, and signamre otnssessor Date signed
complete.
Vaifying actbn - Signature ollwditor Date sgned
20_Pay20_ I
lesser of �i2 Homestead 5
va�uaLqn or E35.000 -