Homestead_Nurrenbern STATE FORM!!'MIB_r Y,M I TREASURER PoRM i}IA
.APFRWFD BY SAVE BOkRD(IF'Ca*,STS.1/x PaUYNBn)BY 111E OEPMTMEMTOrr LOCAL tIOVTLNMO<T FINANCE MVI.I"-r.l
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 hoes-tes'tead fraud.Homestead fraud causes higher tax bills for all:therefore.
HEA 1341--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 necesar-to allow county government to better monitor homestead
filings.This information will be kept mnlideniial and can only be accessed by authorized county officials.The Detarrntem 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
Nurrenbern, Timothy W/ Diane
R 2 Box 8 '
Haubstadt tN 47639
11032
Timothy W/Diane Nurrenbern
2070E Presley Lane State Parcel Number Legal Description
Haubstadt IN 47639-7969
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(17.?
PART 0
/ 004-01886-00 COUNTRY AYRE EST 21
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
77.290-14./ �R)//7-L /Zr.%Y 4rrI
lag Address(nur$er and street,city,sate,and ZIP code) _- ame ns prupem address——-- - -
spouse Middle Last
//Ant. eG'/�Z; ' i" /!�/7^ ,rini
Mailing Address(Number and street,city.state.and ZIP code) 1'{e as property address
Each undersigned certifies,under penalty of perjury,t at t e 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 1 Si attire Date
Y`� �•� t CLAIM FOR HOMESTEAD PROPERTY TAX
a; CREDIT/STANDARD DEDUCTION
,�� State Fortn 5473 (R2 / 5-92)
`\7�7'
yu
INSTRUCTIONS: See reverse side lor (iling instructions.
�
FORM YEAR
HC10 p0��\
'a�Y,TVl la"f�C :a:"'•..
'We) //� i/i.l%l�Q �Y— ��(/i1� � certity that on� ft� 1 9LyN��( ch, 79
�e) occupied as our principal place of residence t f lowing described real property for which a Homestead PropeAyT� �� i5`M1E�Mby claimed:
� I(We� owned ❑ Are buying under contract ' / /)
� I "{,{. �/
❑ Have a beneficial interest in the eniiry that is liable for the property ta�ces on the property and thai owns the ��jrri�iim�?P�d�OHtra"ct.
GIBSOti : OU!-I i Y AUC!?OH 1
- - ' � - � . -0ONTRACTRECORDED�;-_ �-�5 �. � -
If brying on contraa, Fee Simple owner's name .
Recorders oHice where contrad is recorded Fecortl numDer Paga
DESCRIPTION `.
u 7ownship T���
Parcel number Legal de5ti tion
�� � �
If any portion of the resitlential structure or the lantl nol exceeding one (7) aue �hai immediately
af the properry utilized to protluce inmme.
i�i�0 � /7i;
Counry
. PROFERTY OWNED BY
Township
certify the above siatements are true, correct and complete.
(numberand street dry. state, Z1Pwtle)
S i S � G'1�.�/�� B�
Counry
Signature
is used to
� ,—. .
i
describe the use and portion
,���--ASSESSOR USE ONLY ` . TRUETAX ASSESSED HOMESTEAD� . NON-RESIDENiIAC
� � , - - VALUE �. VALUE VALUE . � VAWE
Land not exceeding 7(one) acre immediately - . � •
surrounding residential improvements. (�) � ��
Otherland (2) ' ���
�
Total land (line 7 plus line Z� (3)
Owelling (d) ' � . - .
Residential improvements . � . , .
Garage (5) . � �
Other improvements (6) � � � �
Total improvements (line 4 through line � (7)
Total value (line 3 pbs line 7) (g)
I hereby certify the above is true, correct, and Si9nature of Assessor Da;e signed
complete. -
'tyirg action - SignaNre of Auditor Date sgned
. . ' n
79_Pay19_
Lesser of 1l2 Homestead
Valuation or $2.000
�
I Dare signed
/ — �
