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STATE FORM 5150(PJI&la) TREISLIOA FORM T5-IA
• APPROVED RE STATE BOARD OF ACCOUNTS.21)39 PRESCRIBE BY T11F.DEPARTMEVI OF LOCAL GOVERMENT FINANCE IC bt.I-Ildl
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS .
- 101 N. Main Street Individual: and married couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
A Princeton,IN 47670 more beneficial,there is more incentive than ever for homestead fraud Homestead fraud causes higher tax bills for 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
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.
IL ED PART 1: PROPERTY INFORMATION
— f L Taxpayer Name Location Address
q q Mann,Arvin C
PA 1 ``(`�Ot1�\ 2622 W 1300 S
rn. V V �" HAUBSTADT IN 47639
9872 C-4 •
1ooR
62� $tA1n IDDII rDIDIIDDIID _DIIDIDII I DI - IIIIDID! JIiIIIDIIDIIIDIDII I"
S
HAUBSTADT IN 47639-8702
d1IlIIIIIIII I11111"1111111111 IIIIIIIIIIII'IIIIIIIIIIIII State Parcel Number Legal Description
26-22-15-400-000.660-025/ PT ESE 15 4 11 20.7687 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.
v — r _ —
O First PART 2:TAXPAYER.INFORNIATION f.
Middle _ 1• _._ - _
Last
•p l tit,. I - l // ers . C C .
Plan /
Mailing Address(number and street,city-state,and ZIP code) E Same as property address
a6a tnj ► 3oo S
Spouse First Middle Last
NJA
Mailing Address(Number and street,city,state,and ZIP code) n Same as property address .
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Part 4 below)
I I I I . I . I I I =ti
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.
Owner Signature I Date
WNM HC 10 7979
PreuriDeE By SWte BwrO ai Tax Commissioners
To & FileO in Mplicate
CLAIM FOR HOMESTEAD PROPERTY TAX CREDIT FOR YEAR 19��
SEE BACK FOR FILING INSTRUCTIONS
`� (N1e�� �•� certify that on the 1st day of
� arch, 19�, I, (We) occupied as our principal ce of residence the following described real property for
which a Homestead Property Tax Credit is hereby being claimed:
I. (We) � owned aO � ��D ��� ' D�
❑ are buying under contract � // (`
❑ have a beneficial interest�n the taxpayer ��p?A�� �— �' [v(p�— �T
Property Description
Taxing District (�6ifp-Tewrt, Township):
Parcel Number
If buying on contract: Owners name (�� simD�e
Township
or legal description shown on tax statement:
Pf E� SEs% /s-y-i/ ao.���7a�,
Contract recorded in Recorders Office - Record
If any portion of the residential structure or the land, not exceeding one (1) acre that immediately surrounds that
structure is. used to produce income, describe the use and portion of the property utilized to produce income
.
Any other counties in which individual owns or is buying real property:
�hereby certify the above statement is true, correct and complete.
.
�, `)-r�.�,.�. _
Shee� AQQR55
:�
County
Township
30---�,- ,
ana Zio Goae • ���
' Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Lantl not exceedin�(o�) ac�imm�iately
surrounding reside i rov ents �
Other Land
Total Land �UN
Residential Improvements
��
Other Improvements
71979
����c�.c=4iC17�L Dw�ing
Garage
AUDlTOR Total
T'�' Improvements - Line (6) plus (7) equals (8)
I:�by certify the above is true. correct. and complete.
Approved
True Cash
Value
(�) S�oo
(2) 3 / � o
r3) _3 � s�o
(4) // �>a?O
(5)
�s> / / 9 D
(�) —
(8) / / �i'�? O
- ACTION BY AUDITOR -
Assessed
Valuation
.
.�
� '
.
Homestead
Valuation
—�
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j/�j/�jjjjj
Saa��79
Date
Date: (p� l 1 �_����