Homestead_Ambrose (3) A
Q
SLATE I 011N5'ta Ill' el TRE1NEE1 roLM TIA
APPROVED by SrsTE BMW CIF ACYRrMS.:n,, PILMAIDFD BY mF DFPARnNENT Or LOCAL COVERNMrKT rb:A\CE n'.-I.I-r-LI
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individual and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial.there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
• HEA 1344-2000 requires taxpa.ers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be Lept confidential and can only Ks accessed by authorized county officials.The IkpaMxnt 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
Ambrose, Thomas Raymond/Joan A
R 3 Box 334
Ilauhstadt IN 47639
10843
Thomas Raymond/Joan R Ambrose
11270 S 50 W State Parcel Number Legal Description
Haubstadt IN 47639-8804
111;111,1111111,1111(11111111111111,111.1111111111 Illu ulnll 26-23-07-100-000.019-024 004-00019-00 PT NW 7410 4AC
PART 2:TAXPAYER INFORMATION
Owner I I First Middle Last
A4I let ce
lg Address(member and stmt,city,state,and Z1P code) - --^ - '_-
• Same as property address El
l 70 S7 5-0 toe sr- //Au-hsT4-- 1 ne- 41- 763
Spouse First Middle Last
Aw R /4744 (3 ro S -2
Mailing Address(Number and street.city,state,and ZIP code) 0 Same as property address
/1 2 7 0 5 co l,!I e S r
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
CREDIT/STANDARD DEDUCTION
State Fam 5473 (R6 / 4-03)
Presaibad by the Department ot Local Govemment finance
INSTRUCTIONS: See reverse side (or (ling insfiicfions.
, FORM I"
� HC10
�
n
YEAR
I(We) l,J�/ I /"��I-� ��(//'Yt�(CG�Q� certify Ihat op�the 7st.� of March, 20
I(We) occupied as our principal piace of residence e followin described real ro ert (or which a Homestead Pro eA a4jat Cre�
9 P P Y p y L' d t��Rhereby daimed:
❑ I e owned ❑ Are b GIBSON COUNTY AUBIfi6Ft
(�'v ) uying under contract
' Have a beneficial interest in the enUry that is liable for ihe property taxes on the property and Ihat owns the property or is buying under a conUacl.
If buy'u�g on conVaq, Fee Simple owner's name
Remrdels office where coniract is recordeC
Record number � Page
CountY Tnvnship Taairr�ifistrict (ciry, fown. fownship
i
Parcel number Lagal description Is ihe pmperty in uesGon:
-a3-o�-��o-o�.o� -� Nc� � y�o v�� ���„o,��, OMObileHwno(I.Q61./-7)
If any portion ol lhe residenGal sWqure w the WnA not exceeAing one (1 j aae that immeEiatey wrrounds that shucture is used to produce incame, tlewibe the use and portion
of the properry ut0'¢ed to produce iMOme. �
QOyDOOIgOa
�� `-���'ln . x " �� �� � "r � '+t'" � �� Y''TRUE TAX �, h ASSESSED VALUE HOMESTEADy� 6''�"'��+tNON-RE5I�ENTIAL��
�xv ,p�ASSES50Rl1SEONLY � �' "�� �y4. ���' � 4 t x ,(> i�r u� •c}
-!�7.R.'ii:Y....+t R 1�1�`.'."'�."a . rr . d. .�.%'�i. : i�e. VALUE::".a..� �. �. AT 100% OF TN� m,�; VALl1E� �t �y�s"fx�kk.�S.VALUE..i�? a!:�
Land nol ezceeding 1(one) aae immedialety 4"� ��++�<y��� -"�,�� va
surrounding residenUal improvements. (�� �: �'k �ti��� `� �; �'
"c'.itF`.:.r�.;��.i., �
.�ra!��T.k''���. .w:� ��:'
Otherland (Z) - �5++� ���
F'��:i. �...�..
Tdal land (line 1 plus line 2) (3�
�,n. ^<-a}1 ��s `f`F�� _�;
Dwelling (4) �°�,,;'�Z�.��.a'��� �5'ri��"y.�s`�i�i
Residential improvements or Mnualiy � �
0.ssessed Mobila I ManufaUUrad Home Gara e '� s�� �
9 (5) '-1. �`,.s.n�'�u,._y�� :.�� ._.'t`i.��
-.. ti�.4,y � .-.5= ; Y '
Otherimprovemen[s (g) c�"..-� `, J=`F-
a.: C'C •-•. °jx?`y_
- ?�a .
Tdal improvements (line 4 fhrough Irne 6) (�)
TUaI value (line 3 plis line n (8�
1 hereby ceRify the above is We, corred, and Signature otnssessor Date signea
comp�ete.
Veri(ying action - Signature oflwditor Date signed
"cs°t' z.;?� .-"�'�-e:�:'e1�r��,�:':�'.�.is;.'r�'t'��:`� :`STANOARD:DEDUCTIONALLOWANCEt -_'<-s �,=a.rn- 3�Y .;;,�6.�! •,+ '�n.ie
It�`.�� h.
• �' cu �.a�3'r�d��.rRTucA K't.��%?T.�"�Ft��?.'z:.Y�}�'.:�
20 _ Pay 20 _
lesser of tl2 Homestead
vguauo� w 535.000 g
SgnaWre of Auditw " Date signed