Homestead_Johnson (5) Star£FORM!JK tR/uMt TREASUID FORM 711A
APPROVED BY STATEBOMR O Ar.raLTS nNN PRr9AJBm BY 11117 DEPARTMENT rrtLOCAL GIrRNSIEbT FINANCE IC<I.t1'.4.1
Gibson County Auditor
11 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N
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 eser for homestead fraud.Homestead fraud causes higher tax bills for all:therefore.
dam-
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verity that they are eligible to reeehe the
benefit and to provide additional identifying information necessary to allow county government to better monitor hortrrste:d
filings.This information will be kept confidential and can only he 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
Taxpayer Name Pnrperty Address
Johnson, Jeffrey M/Judith A /0.2 0 1 3 400 tJ
—ltr ease
Fon Branch IN 47648 rQVL
-
2643 �G
Jeffrey M Johnson
10201 S 400 W State Parcel Number Lena! Description
FORT BRANCH IN 47648-8160
26-18-33-300-000.005-024 004-00005-00 PT SW 33-3-11 1.85 AC
IIItuIlttuIiIIui,IuiIIirlrlrtlrtrrllrllirllrttll Ilrlrlrl X 0-2
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
Owner I First Middle Last
SE-PEI2Ey MARX \J o N-N!.O Ni
illtg Address(number and street,city,state,and ZIP code) - . Same as property address
o 2o� s 40 0 in Fr. �12I�+vf
Spouse First Middle Last
SAD, T14 A-kr of ���,/////\o f N So NJ
Mailing Address(Number and street,city,state,and ZIP code) L'J Same as property address
1021o1- S '-oo W F,- f32A-r10.)-4
-
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.
O %S c Date
•
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
smm r� s�re cR� i sou�
Raffi3ed by Ihe Depatrrari of Laal Gorerrcnad Fawim
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I Mle) owr�ed ❑ Pre buy"ug under cantrad O�< ��S/Sk1
GIg SON �
Have a benefidal 'viterest m the enfily tlwt is liade 6w Cre popeAy t�ces m the propeAy and Mat owns C�e property or �s �L�ct
M Wy"oq� on m�tra� Fee Simpe orn�efs rerte
F�mrtlels at6�e whae wmad'u recaded
y < .�: tro `.�t '.I:'..,... . ::'NsV:
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Rewd number � Page
Parcel nmma LeB� desaipOm Is the papa�ry iyn �� :
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M��of the �u9ucGae w Me Imd na1 �ceemrg one (1) aae tl�et inmed�. svrtau� tivt �re ia used b produce iwmie. desTba fha �ae and pation
ilif�db mmrrie.
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Counry . Tawnship Counry Tawnship
I f�ereby certify @�e ebove 5fa�ls aie h'ue, cortecl and cortqlefe. � _
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�n,,,t� enn �eet on: amm. zw mde, G�
0 0/ p T, � �v 6'-/� .,
i s`�,�r��r��t,i�� ASSE3SORUSEOMLY`{' �` �`F�����'s� ��" iRUE�TAX t�. ASSESSFD VALUE e��5TFAD �„ ,n�'y�r�'�`rNON�DBdT1AL�w�i��'
.;�1. Y.:+, zic'�, +..L. :a ar..� ��:+'Y�r„�°v�. �`'' VALUE�n � . AT�100XOF�7TYJ t� ��:VALUE 9at;` F°v�;bs� ��'.r. tV/ILUEy,€'�'�1«:e,i.
Land not ezceading 1(me) aae irtmedia6ely .. , � ." S rs etit�� ,�yY �'��fit'`.''2i s�s ��
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Tdal land (!»e 1 p4u 6re � �g)
'S ` Q�s�z s x t4 },�, �jttW9p'• ;'
RESldenti2l RfIpfWBf.lEf1(S of Anfiu211y ��n9 `4, �' rr.`,���,��'�'J��.-.it�'�.-�s��.,.5`'�"E�°�
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� ��'I ir-if+�J�.15�F,fijs,s�•f5n i..�1��;N�jX�
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Otlierimprovert�ents (6) �a �
,_i,.,,�.�, ���.,�n�:.
Tdal unprwert�ts (�ure ! tivwx,p� Bne 6) �7�
Tdal value (I'are 3 phs 6ne � i8)
I F�erMiy oertiy Hre above is We. owred. and s�gr�mae Mn�svv trah sig�ed
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Vaiy'ug aaim - Si�ymme ol h�m. Qate s�ied
.r � " . r •,." ..� ,. , � : ir�STM1DARD�.OEDUCT101iALLOWAMCE'. `' � � i�+11u . �.:i_, r s' �'.,.. u-�: i*:a}.. .�� �v''
.t ,,,t.k. n.rr_.a� r?ae.. � i�
2Q _ Pay 20 _
Lesser oT 12 Homestead
Valuatian w 535.000 f
Si�altrte d/4�drtar � s��