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Homestead_Haley (5) STATE FORM 53500(113/840) 1REASL71.121 FORM TS-IA APPROVED RV STATE BOARD OF ACCOUNTS,3(W PRESCRIBED BYTHE DEPARTMENT OF LOCAL Co41A'MEYI'FINANCE I[b11S12.1 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, _ HEer l344-2009 requires tacpayers who receive the homestead standard deduction to verify thy[they are eligible to receive the T T { nefil and to provide additional identifying info ma on necessay o alloy county go eminent to bee monitor homestead le L,L 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,elimitate homestead fraud. APR 18 2011 PART 1: PROPERTY INFORMATION • - Taxpayer Name Location Address- _ C ��\"sy Haley, Kent T/Leah M - "GIBSON COUNTY AUDITOR /\ 9764 S WATER TOWER DR C HAUBSTADT IN 47639 . 2290 . I ILIDI _D lI I IIII_II. 1110010 00IFII0I0 II_IDID 00 0 1011 11101 Kent T Haley 9764 S Water Tower Dr HAUBSTADT IN 47639-8843 It1IItIII1I1IIII1I1I"�'I'III' 'Ill1lll"IlIll'IIIIIIIIIIIII'I'l State Parcel Number Legal Description 2648-36-200-002.321-024✓ WATER TOWER PLACE LOT 26 - 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. r 1 - PART 2: TAXPAYER INFORMATION ON. I First Middle Last vi- --,-- //007/9_,5 • ,q4 gui , Mailing Address(number and street city;state,and ZIP code) - • © Same as property address t. `17('4 5 , \ lERrcwut AR (-Ihw3S-T# 6T - /l) L47l,ell Spouse • First • . - Middle Last «A-H /4/9/2/E /1/1-1E'y . M a i l i n g Address(Number and s t i t city,state,and ZIP c o d e) - - - •EaSame.as Property address. - — 9 7 r; 4 F S. w fr t r i z YO IQ /t OA Ih14LI 0 5T4/d! -,t- A/ 4'76 37 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 ? • I. • Cl1�lA1 FOR HOMESTEAD PROPERTY TAX CREDfT/STANDARD DEDUCTION S�le Fortri S173 (R7 � sO� Prea�eA by Q�e Depertrnent of Lo�l GorermierA Fv�anae INSTRUCTIONS: See ieverse side /or filing insbuctinns. FORM HC10 M � „� „- � •,: � � ,. � .., ..- ;�.. � . .., ,., �...,: ._,,........ ...� ........ ........�.r....:e �.t-,,.. — . . ,.., :_ . _._ .., _... , ... . _ _ . _ . ... � a. �.x:_.ue� _....n.4 �n_. ,. � t••e� � � m9i� IFZ Q3Y O( M2IC�1� �_ � M�) �+P� es prvrciPal Plaoe of resider�ce the fo9ovrirg desrnbed rPal properly for which a tead Pivpa��t1y T� t is hseby daimed: ��(We) owned ❑ Me bt�m�g unda cantred � N "�'����� Have a benefidal 'v�terest rtm fhe entiry fhat is liade fw tl�e property fines m the popaly and Cat��� �ik �smymg under a contracL �2]'..�a ir f ',::n`y., ° � yy!� �-�i' %�CON7RACT:(�CORDmxr]i�s r {� 'tJt.`• �iti � ."`at. � P' rr. ) . ..!5. >�. �,i„ n•.. i .� .t 3, ssGi: k�t ..S C+3% is x.s� . -..., ...,,. �. .. _:. , ... . IF buy'1g Om m�hacf, Fee Sirt�le awnere �v1I18 � fLamEer§ d5c� Mw+a m4ac1 is recn'ded Recud number Pepe �l 'b ' IX "JIO" e{�J1� E�J-I x am v� wu�e � smtime a d ihe papairy utiimd m pmmra'e�mne. Ta�slup Legal d�aipBan wa.w�c��w��', - - , c.-.: .�, Tamg d"auicl (cly, 6-irn, towuh"y) Is Uie Real P�verb LJ Mabik Flonie �ICBB�11010118 �i� ffiB U131 IlIREQt�01y G111U181� � btiUChdB Iq USBd ID WOd1108 RIWrt18. dCSFbB a1B IIIB 811f� POli1011 �tP � . y: r � c ASSESSOR USE OAlLY ..� t£ +Y�;�P ��.�" TRIfE TAX K l: ASSESSED VNLUE �, HOilESTEAD .�:, T�` NON�iESmB171NL�'��i 'G .t� r3 S �� ,...t - w...�. � � � f'..-v fi w��..UE' �:AT 700%� 77V L � VALl1E �,'`.i .! �y�..k:..��;; VALl1EY t: ef�;i�,ai'� Land not eueeSrg 1 (one) aae irtrnadiately : � '��t' �! "v'; �;+t > � rs. swdr�d'ngfesidential'vr�pro�K:fllenb. i�)� 'r�s�i$ni'�yM., i, •,��ja /f�� ��`, � on�r �m •'.` �`: '' c2J `' ' �•�~ .:��J„�.,�z.;r;, Tdal land (la�e 1 ph�slme � • .�g) . a Sfi nfu4�3i �k.s i4ry 4° r{3��i�' rtesaennal anprwa�,errts oranrwaly °we6`g - �a) ,' ;V �� ���'L^$.�ZL✓..:'`�"r�,�v ASS�SBd MOh1�E! M2fWi8�I0d i�Q118 , i}�'�.' �4' �y,,,� t� -:D�t4 aa•r:S,. ��C �� � y�`� �� Q/ i3 i�? �a,�,�'���? �i3�.`.-'+xr -0f.ii�C�-../f� .ti' .: 'c'1�'. p7 � :� OIhBI1f1I�fOVCfflEntS �6) �' ; � w'. TdB� RIIPfOVB7fI8f115 (fIIB � HYDI/�1 �/IB � �]� Ti1al value Qcre 3 pks Gne � (g) I hereby oartify tlie above is We, ovfed, ard si�mra ofnss�ao Date sigied �� Vaityirg eakn - Si�ame of p�mr Dam si�ed •• 1 �-� ,i::�c - • ' ; �, F ,r'STMlDARDDFDUCTION/tLI.OWANCEr � '-�,w-' ,>aso?u�:'r,°.. `� ��1��'�.�Fe'� 20 _ Pay 20 _ Lesse� of 12 Homestead Vauation or 535.0�0 S . Si�ae dPudm. �b �