Homestead_Kelley STATE FORM:W..0C'/WI) TREASURER IO11 SIA
SPFR(WEORY STATERMRO OF AOMU7.1,w PAEAtInw BY TIn OEPART\@`lrOr went CAmaYNEA7 FINANCE IC 4-1.1-r 4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead 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 fur all;therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing`.This information will be tept confidential and can only he accessed by authnrired county officials.The Ikpanment of
Local Government Finance will use this information to create twls that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Kelley, Jeffery D/Kimberly L
R I Box 305
au stadt IN 47639
10868 rL b
Jeffery D Kelley ��Zi
108E 1200 S State Parcel Number Legal Description
HAUBSTADTIN 47639-8814
ItI IlutltllunIItltlul ,ItItiInnlltlrlllntlrtltTtITII— 26-23-07-400-000.165-024 004-00165-00 PT E SW 74102.20 AC
PART 2:TAXPAYER INFORMATION
Owner I First Middle j �� Last
m&r) Lc l y
•ng Address(number and streettcity,state,and ZIP ) - - MirSame as property uddi -- - — -lode E
/ S PQL bS-+Q,d4 ►v q7C3 Qj
Spouse First Middle J J I Last
JQ-W-Pe_ry 1:1)-2_cc, K C_,1 1 c
Mailing Address(Number and street.city,state.and ZIP code) [Vine as property address
108 E H Q.k..L.s gcLf, Y7(035
PART 3:CERTIFICATION
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is aye 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 Si! -tare Date
1
;; rt�� t CLAIM FOR HOMESTEAD PROPERTY TAX
i:� '" CREDIT/STANDARD DEDUCTION
.�<' SUteFOrm5a731R2/5-92)
��u
INSTRUCTIONS: See reverse side lor filing rnstructions.
. . - ,.' � - _ -'-��CEHTIflCATI
FORM
HC10
YEAR
— ������::�-„
I(We) certiry that on th t d1ay�of �, 19_
I(We) occupi s o ' cipal pla of residence the foliowing descri � prope ' mest� ad Property Tau �redit is h� daimed:
�I (We) owned ❑ Are buying under contraci � �/Y�Q� - ' • � (-� [/,('� �
Have a beneficial inierest in the entit that is liable tor the ro ert taxes on the m e and that owns i e m or-�s bu 'n �undei axonqact
Y P P Y P P rtY P PertY„�,�� �Y�.9� �,.���':1� .� :
- . . .. - CONTHACT RECORDED �= � ' � . .� � -. . . - .:�..,: �
Ii buyirg on contract. Fee Simple owner's name
Recortler's ottice where coniract is recorded Record number Page
� � � � � �� � � PROPERTY DESCRIPTION - �
County Township Ta<irg disVia (crty, town. rownship)
Parce u r Legal descnptio
_ �� _y-
It any ponion oi the resWential strucwre or [he land noi exceetling one (1 � acre ihat immediatety surrounas that structure is used to
of ihe pmperty utilizetl ro protluce inmme.
�I�l-p�J-U/- /UU-V(l[i.
� PROPEHTY OWNEC
Counry Township
I hereby certity the above statements are irue, corred and complete.
�
IN OTHER COUNTIES
�
�
irmme, describe Ihe use arM portion
� � ASSESSOR USE ONLY � . TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL�.:
,. VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately - � � �
surrounding residential improvements. (�) '�
Otherland (p) �.���� ��
Total land (line 7 plus line 2� (3)
Dwelling (a) � .� �.� �" ..
Residential impmvements , -.
Garage (5) ' ,' "
Oiher improvements (6) -
Total improvements (line 4 [hrough line � (7)
7otal value (line 3 p�s line � (g)
I hereby Certify Ihe above is true, corrett, and Signature oi Assessor Date signed
complete.
Verilying action � SgnaNre of Auditor Date sgned
79_Pay19_
Lesser ot 7l2 Homestead
Valuation or 52.000
3
Synature ol AUditor �a�e s�yneu ,
�„n, -�_�9-
,