Homestead_Potts L - STATE FORM 535M(R?/RIO) - TREASURER FORM TS-I A '
APPANFD BY STATE BOARD OF ACCOUNTS.ixp PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC 61.1.1111
Gibson County Auditor IMPORTANT NOTICE TO HOMESTEAD 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,
i.. HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
feingst and to provide will be identifying confidential tial and ca necessary to allow county gmdreo nt oto fficials.better monitor homestead
of
filings.This information will be kept confidential and can only be accessed by authorized county of5rials.the Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION .
APR 7 2011
Taxpayer Name Location Address
C.rJ-rfw -1 Potts, Chad W/Laci L
369 E HIRSCH WOODS LN
-GIBSON COUNTY AUDITOR HAUBSTADT IN 47648 ,
3020 .
Chad W
E Hirsch Woods Lane 1111111 iIII111I11011111C II IIIIII II 111111111 II 101111 II 10111111111111111011 III
HAUBSTADT IN 47639-8830
IlllllliiIIIIll'II'IIIIlIIhIIIilIIIIII'll1'llJld'lll1l'llll1ll State Parcel Number ; - Legal Description
26-23-07-200-002.024-024 PT NE 7 4 10 1.12 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 .
a, i ^ had} First ` f n Middle /-� Last
U W nS�O G tth )h�
Mailing Address(number and street,city,state,and ZIP code) ) 1 Same as property address
3■ R E 14-irsCh \\Iooels Ln OaubS}-0,44, \N L\--/ 03(i
Spouse First Middle Last
Lau Ly ne+1-e. Po +ts .
Mai .(Numbcr'and tit C,citrtaiCandZIP code) - . -.. ..___ S:une aspropeny&ddrees _ —..
- - 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 fmancial penalties. _ ,
Owner I gna Date
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
t Stata Fortn SC73 (R6 / 4-03)
Prescribed by the Departrnent of Local Gwemment Finance
INSTRUCTiONS: See reverse side lor filing instn�cfions.
0
T.�1 I ��
FORM � YEAR _
HC'ft�
FEB 07
��e� L�1��`=� ��A�� ���� certity that on the 1st day of March, 20_
I(We) occupied as our principal place of residence lhe follmving descnbed real property for which a Homesiead Property Tac Credit is hereby daimed:
I(VJe) owned ❑ Fve buying under contract
Have a benefidal interest in the enliry ihat is liable (or the property taxes on Ihe property and Nat owns the property or is buying under a conVacl.
If buying on conirad, Fee Simple owners name
Rerordefs office where coniraq
Caunty
7�
Tavnship
town,
Rewrd number � Page
a� � r�u� , ��7 � i ae�s/cn� uon ��77 �
'��0� —✓'� 7' /� �'�' IC7 Is Ne ProPe!ry i�Realstio�n:
9E v�m ❑ Mobile Ho o c�c c.� ,-n
H any poNOn ol the residentlal sW ctura or the land not ezceeding one (1) aae Ihat immediatey wrtounds ihat swcture is used to produca income, tlesaibe Ne use anA ponbn
of Ihe proparty utif¢ed tn produce income. � �a A�
��� dG-a3-o�-�a� -cba.oa� c�s�
rt�s_2s�t `� '� ��-°�y'.::.:.'�'�1'S'i' � ;4� •s n y � n n... +T,� zt - . c�e.,u- . . ..�..
�a.,�� �pS5ES50R�USE ONLY �� ;� � Q',1, FRUEcTAX�� � ASBESSED VALUE � HOMESTEAD y NON�RESIOENTIAL t
x��'�",La<ii�.�•"--�-'�.-:?��'r�k.�d`2?�a.:.`4:i.-�5.��.',.?;:�19'�VALUEy-t.�t " ATi100%OFtTfYA�VALUE.�`�?��.k'�+.,�.'-:�.w�'VALUEj��,�»',.�`'ks.���
Land not exceeding 1(one) acre immediately �j �` s�j� � �--; �.✓�
✓`
surrounding residentlal improvemenis. (� � ��� �1.`�'�v`. ��� ��., �, 4 '�i
__ Af�
Other land �Z) y � `� � ����:�
;�f.. � x:: �
.�+.'a""_e+-s�..._
Tcial land (line 7 plus line 2) �3�
���':=x�. }3+._ -- �._ _-y,
Dwelling (4) ��`��� ������si�.�.
Residential improvemenLS or Mnually ���- L�' ���
Assessed Mohile! ManufaAUred Home Garage (5) ��c ��� -; r�� �
�y 4
�= � �'-1'�'�'.'�
�v k- �
Other improvements �g) ���'=r�� �-1�=
T.c�v:.=w,�'l:-a,.
To1al improvements (line 4 through line 6) (�)
kial value (line 3 plts line � (6�
I hereby ceAify the above is W e, coveIX, and Signatura of Assessor Date signed
complete.
Veritying ac4on - Signature ofAuditor Date signetl
���i,�``.°�.`'-`�t��,,.,.�`�=`F`iR�.��Y:s-.�`l,r.��su'`�`�`}:`�'.+iSTANDARU'.DEDUCTIONALLOWANCE���'"'�,'^,�i�;�,si,��;"'� . y�$: T'.,:jYq'ig`.:.r'1&'F-��'h,�e,�„.:.�_
20_Pay20_
Lesser of 1r2 Homestead
vaivauon w 535.000 S
SgnaWre of Auddw ' Date 5igned