Homestead_Lamey (14) i
STATE FORM 5MM IR'r 4M1 TREASURER mtM 75.IA
.AIRovEf BY 510E O MR°OF AM1YA1MH.anw PRFSMBEm BY nIEBEPARTNr.YrfFLOCAL rovEtNS1rNr FINANCE MHa.22.1.1
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 ter for homestead fraud Homestead fraud causes higher tat bills for all:therefore.
HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are elirrible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filings.This information will be kept cont:denial and ran only be accessed by authorized county officials.The Ikpanntnn 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 Property Address
Lamey, Chad J/Andrea L_._ _
- R I Box 339
Ilaubstadt IN 47639
3351
Chad Lamey
11538150 W State Parcel Number Legal Description
HAUBS ADT IN 47639-8753
It�tt�ittt�t��rttt��t�t�tt�t t�t� rt�t�t�ttt��t tt��t�tP�r�tttii 26-22-12-300-002.122-024 004-02122-00 PT NW SW 124111.048 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
Owner I First Middle Lass
Chi -0-cuvnes L a-me-9
•tg Address(number and street.city,state,and ZIP code) Same as property address
538 S . 150 W • - am. 5--oa4 'TN 4-1 (0 3 9
}-r■dtirea L� n n L (LW) Qwj
Mailing Address(Number and street,city,stale,and ZIT'code) Same as property address
11535 S . ISO 143. I-Eattb5+
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 i ` [
rt t CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
/ State Fwm 5473 (R6I403)
Presaibed by the DepaRment of Local Govemmenl Finance
INSTRUCTIONS: See revcrse side !or filing ins�mc(ions.
FORM YEAR
HC10 �
'1 l7 1T -'�i —_'{
� � � 3�i r
� (we) , �-%� (L � � �
certif"y that on�tst day of March, 20�
e� e%� , lf
I(We) occupied as our principal place of residence fhe following descdbed real o erty for which a Homesle `Ptoperty`Tac�Credit (s fieietiQ�daimed:
� I(We) owned ❑ Are buying under contract �` GIBJO?� CGUt7 f Y AUUI i V 3 i
, Have a benefidal interesl in ihe enlity that is liable for ihe property taxes on the property and that owns the property or is buying under a conUaG.
If huying om m�Vad, Fee Simple ownefs name
RemNels ofice where conVacl is recorded
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CouMy _ _ Tamship
Record number Page
6.��.i'.-ni�^'Q' �i� �.cf"'}`w`"8,?x'.tx»:�.�.£�i....'.��s„�'id'atc�6Y5
tawn.lownshipL _
Ybl�Jn�Q�/�� —�� IT � QWP VW /�— 7—�, /� Il�e�pG rty" question: '
� �Real pmperty ❑ Mobile Homo (I.C. 6f.1-� .
H any poNon of Ne residentlal sW cture w the land not excaeEing one (7 � aae Nat immediatety surtounds ihat sW chue is used b produce income, desaibe Na use and portion
of the property ulilaeC to produce income.
County
Tavnship
I hereby certiy the above statements are We, corted and complete.
(numbra end SVeef, ciry, sfate, ZIP cade)
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20_Pay20_
Lesser of 1!2 Homestead
vauanon a 535.000
$
SignaWreofPUdilw " Datesigned