Homestead_Long (3) STATE FORM 535MMR3/8-I0) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.MP FRE_SCFIBED BY THE OFPARWEV1 OF LOCAL GOVERNMENT FINANCE It 6-11-224.1
Gibson County Auditor IMPORTANT NOTICE TO HOME�TEAD 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,
iii FILED 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 onal i dentifying information necessary to allow county government to better monitor homestead
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 eliminate homestead fraud
APR 2 S 2011 PART 1: PROPERTY NFORI%IATION
Taxpayer Name Location Address
C' 'eneitcy— Long, Shannon N/�Moonnette T •
GIBSON COUNTY AUDITOR X 1701 E SIERRA DR
(/ HAUBSTADT IN 47639
11458
Shannon N/Monnette T Long 1111101 I I.0111111i01ftfill 0III 01011 III 11 111 11 1 III01.I 1 10101110110110101011 1111 .
1701 E Sierra Of
Haubstadt IN 47639-7976
111111111111'lllll'II'llIlll'1111'IiIiiIIltltltllllllllllllrllllt State Parcel Number Legal Description
26-23-16-100-001.920-024/COUNTRY AYRE EST#2 21 D-9
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__ t _
kit
`lCKKO✓!_. First i/e/ / Middle / O Last
Mailing Address(number and street,city,stair,and ZIP code) ® Same as address ,
/7oi E 5;e//et P • f7Aw61s7/.,¢, -77/1 z/7637'
S t55ey� Last
First Middle
/%on/7ez __ 7-7-a c-y Z-0n -
Mailing Address(Number and street,city,state and ZIP code) caSame pent'address
/70/ t 5ctra ea'Aey� s" t'73r ca
t 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 for back taxes and substantial financial penalties. �
� N� . CLAIM FOR HOMESTEAD PROPERTY TAX
` " ' CREDIT/STANDARD DEDUCTION
`� � State Fortn 5173 (R4 / &00)
u�.
INSTRUCTIONS: See reverse side !or filing insWC6ons.
FORM
� EAR
HC10 � O�%d"
I(We) wtJV v � w� � � V Y V✓��" " certify that on tfi� 1st d�y.dPMa�di}261 �1
I IVJe pied as our prindpal place of residence the following described real prope o which omestead Property 7ac Cr reb ed:
(We) ovrned ❑ Are buying under contrad ��� � UY��
lave a beneficial interest in the enti that is liable for the ro e taxes on the ro e and that owns the ro ��
ty p p rtY D P rtY p pertY or is buying under a,conVact.,
If Duying on conVac4 Fee Simpie ownefs �artre
Recordefs oFice where contraG is recorded .
�. � RecorE number � Page
Counry TpvnshiP Tadng distrid (ci(}; . tow iP)
a � e'� � O O Legal desuipGon
V
II any poNon of Ihe residenLal sWGure w the Wnd rwt exceeding one (1) aue Nat immeCiatey surtounds fhat structure is useA to produce inmme, descriDe the use and portion
ot Ue property utiGzeC to protluce income. � � .
��-�3 i�-/�o-ao%9�o-va�
I hereby certify the above statements are We, corred and complete.
Land not exceeding 1(one) acre immediatety
surrounding residential improvements.
Otherland
Tdal land (line 1 plus line 2)
Dwelling
Residenfial improvements
Garage
Other improvemen4s
Tdal improvements (line 4 through line �
Tcfal value (�ne 3 plus line �
I hereby certify the above is We, corred, and
complete.
verifying aclion - Signaiure ot Auditor
(�)
(21
(3)
i4)
(5)
(6)
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(8)
SignaNre otPSSessor
signed
signed