Homestead_Claybrooks STATE FORM 535M(0.18-10) TREASCRFR FORM T3-IA
, APPROVED BY STATE BOARD OF ACCOUNTS.X09 PRESCRIBED BY TIE DEPARTMENT OF LOCAL CAATA\MENT FLNANCE IC6-L 1-II4.1
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.
• 0HFA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
4 . benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
,IO1l filings.This information will be kept confidential al andand ss 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
FEB 2 4 2012 Taxpayer Name Location Address
C Claybrooks, Christopher A/Jamie L
12190S50W •
•GIBSON COUNTY AUDITOR HAUBSTADT IN 47639
-
11579
Christopher — y b — - II1ft Ii1101111111111 H IIlOI ilIlil ll III Ii:111111111111111111 ll111Liillii i1
Christopher A Claybrooks
12190S50W
HAUBSTADT IN 47639-8721
1111111"II' 1'1111'III"I'II'1"'IIII'111I'I'II'11111I1'IIIFIIII State Parcel Number Legal Description
26-23-18-101-002.285-024 PT NW NW 18 410 .6510 AC
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.
PART 2:TAXPAYER INFORMATION _
Ow cr I First Middle--- Last
efide1S larfOrell90444 , at c C--A-/ C LA YagOO K J
Mailing Address(number and street,city,state,and ZIP code) ❑ Same as property address
/2/ 90 5 5o W 1-IAVOSrAbr , - rh•l f `1363?
.-
Spouse / First �� Middle < Last
-1 AMSE ` L' CLAYeQooAs
-
Mailing Address(Number and street,city,state,and ZIP code) 114.81ffiCs property address
-- -
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
,1
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STdNDARD DEDUCTION
sma� r� ssrs (R� i s-o�
PreaobaA try Me Dep�trfart af Lo�l Govertma4 Frmnm
INSTRUCTIONS: See reverse side fa Idi�q 'ms6uc&ons.
..i_
., � . . . .. . -' , . . �_ wis, . � [xetmcen
FOR� �
HC10 .
I(We) � '�iDto� 75t ofM
I(We) ocwpied as ow prindpal P of resider�ce the to "rg descnbed real poperty ta which a Hanes peny is meC
�� cwe� �a ❑ Me bu�mg unda mntrad MAY. �
Have a benefidal crteRSt in fhe entity Nat is IiaWe fiw C�e properly faxes m Cie popaly and tlat owns fhe property w �s QiQe' r a cantraeL
.t•',; • � ;:.,.: .. . -: � '�.• � �:! , . �.. CONiRACLRECORDm�;!�y:rd „o;�'„r,ti4:�G163pµEe. ! �.;��;+ �� � t 4`+ a.:;.�.:h%i�
tt b�y'rq om m�trad, Fee Si�le ow�els iame %� U� DI7'pp
Rewd num6er � Pege
' ,..Ar � '..,. .. :.,• . � _: :.. , '.. �QP�TM������� i- . r � : .,'.' / 'n .. `"'tt 4 ��. � .:.:y'���.9
Canb TawrrsleP � Tmm�B disUicl (dy �n. township) � .
d�uiPtim Is the papary in quecCOn:
' � - ❑ Reel p'ope'ry ❑ Mabib Fiorte (LC. 61.1-� �
If mry parlion o/tha residmtlial atruWae w Me Imd nd mdeedng one (11 eve tl�al inrtedro0aly anaads tlul ffiurara is uaed b prodice ncvma. descrbe tha �me aM portion
d Ihe paparty Wi4zed to piod�ce'vimne.
�� n W nw t8^�-ia . �s�a
- - -
_ _.
.+.r� .•.:PROPEIiTYOWNED�BY.CINYANT@I�OTHHtC0t1NTIES}�._';. -�d..;r Z..x„�;';...,.t;.�".'
counry 7v.nsnip -� - cou�ry 7 hi ..
I heieby oertify the above sfa6ements are true. carted and crnple0e. .��'�
(nurbw erd a6eet aA: �m. IfPooee)
ld / o J 50 u v =N 6 J
, r . , .,,�� , , , -._ , � r,N� •,�� .
.
TF91ETA7C ` ASSESSED VALUE FWIffS7EAD ��, i�� �pH:1UlL ��y,
�.g. T�.. A . , .ASS630R USE ONLY . � � � �- . �: . ` �E ..� 'AT 100X OF TN L ` � VALUE � t ��,� �'r' 't.. � � VALUE �c`* :m� kti a
x. .O.f,•• .y. .._.�,-!d� r ,!h ...r.. �S ':�..� �� �S�,+s.'Er.t'i� ,.Prt�"i.�,�S:i �43. V,".
tmwrwae�rgt(me>aaeirm�adimely. �' �.�'t��"'�,��"��;�t��fir�,��,f;°����
surtoundel0 fBSidEflh21 ifliplOVCmCffis. �) .:tY�c?Ne lr�'�.'.i.m��bfi. n�.r."�.-.sa�"�...�i�Tti,
��`�ir � �'"t` .
Otherland �p) ! ?y.{�'��.✓.Y:
Tdal land (lare 1 pkrs �e � �3)
� j�'� $�Y t 4 : t� ��
�MB�flg �4� �� c' ��S �� tk �'e'k R .Y:'�' S' �?.��
RCSdenSal"vry�foveRientSQMruielly .�;.. ,,,Y,��°�":� -,3rhn,}^'�f ya� ,�
Assessed Mohle / Mfarwfarhaed Fiane ��V`�'$y'�'w �'�tls' ��"�.Jt�,�,��N�,
��e (5� �'�...�`r?�, i.�,n� J..J��iF.'3::..:'i....
OfhEf irtlpfOV¢rt1Eni5 (s� i �.:� ±77t! i' �� ••
:vi..t ;'�$ .
Tdal'vnprwanerrts (iire 4 Wwyh 6ne 6) m
Titel value (!ure 3 pks 6ne n �g)
I hereby oerfity the above's We. carrea. and Sig�ve of nss� oate sgned
o�np�te.
Vaityir8 eClon - Si(y�aCUe of AudEV Da� eipned
. - .STANDARDDEDUCTpNALLOYYAMCE z..� ��'',,�`� e:::. � ha$'�:�e""" *LiS::tv}i€q,;���
20_Pay20_ .
Lesser aF 12 Homestead
Valuation or 535.000 S
Si{p�a4ve otAudln DaU sgied