Homestead_Haley i�`� MATE FORM 5M (IC/5+Y1 l,rASLREA FOAM 73-1A
Arrxrw'ED BY AAAlt.&N%O OF ACC* LNTA.22 no MACAWS,BY T111 DEPAltry@4Tt4 LOYAL CNELYNENT FINANCE r-I.I-r-!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 Atandanl deduction.As the receipt of this deduction becomes
more beneicial,there is more incentive than ever for homestead fraud.Homestead fraud causes higher tax bills for all;therefore.
• HEA 1344-3009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to recebe the
benefit and to provide additional identifying information necessary to allow county goverment to better monitor homestead
filings.This information will be kept confidential and can only he accessed by:mihori,ed county officials.The Depanment of
Local Government Finance will use this information to create tools that will h:Ip county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Haley, Brent P
110 West ST
Haubstadt IN 47639
10744
Brent Haley
10683 S Oakddge Est State Parcel Number Legal Description
HAUBSTADT IN 47639-7864
26-23-02-200-001.768-024 004-01768-00 PT W E 24101.51 AC
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PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
f rem - Pa-¢-rick ilatey
�g Address(number and street,city,state,and ZIP code) Er Same as property address
10(4 63 S Oak. R e d 9c-E s'f f `4 bs i1 ..TA) Y-737
Spouse First Middle Last
Iv
Mailing Address(Number and street,city,state,and ZIP code) C] Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
saw
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
�pfor
�back taxes and substantial financial penalties..
Owner I Signature ��� (/ Date
-
• _.
�'`""- CLAIM FOR HOMESTEAD PROPERTY TAX
i �° CREDIT/STANDARD DEDUCTION
�� � • State Fortn 5473 (R2 / S92)
��?
INSTRUCTIONS: See reverse side for filing instructions.
TEMENT
� FORM YEAR
� C V'r��0� �
I(We) certify that on the 15t day of March, 19_
I(We) occupied as our principal place of residence the following described real prope t which a Homestead Property Tax Credit is hereby claimed:
❑ I(We) owned ❑ Are buying under contract ..
❑ Have a beneficia� interest in ihe entiry that is liable for the property taxes on the property and that owns the property or is buying under a coniract.
CONTRACTflECORDED
on conVact, Fee Simple owne/s name
�'s offce where contract is recorded
If any ponidn of the residential struc[ure or ihe land
the property utilized to praduce income.
Counry
one
�UV '
PROPERTY
PROPERTY DESCRIPTION
7a�dng disiria (ciry, mwn, rownship)
certify the above statements are true, wrrect and complete.
ASSESSOR USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvements.
Other land
Total land (line 7 plus line 2)
Dwelling
Residential improvemenis
Garage
Other improvements
Total improvemenis (line 4 through line 6)
Total value (line 3 plus line 7J
I hereby certify the above is true, correct, and
complete.
19_ Pay 19 _
Lesser of 1/2 Homestead
Valuation or 52,000
(�)
12)
(3)
�4)
(5)
(6)
a1
(8)
ro
�(i0i T
NANT IN OTHER COUNTRIES
TRUETAX I ASSESSED � HOMESTEAD
VALUE VALUE VALUE
STANDARD DEDUCTION ALLOWANCE
Cj
�
uu
NON-RESIDENTIAL
VALUE
of Auditor �`!'�� �a�e s nec
�,OM. � � -