Homestead_Rose 'JUL Ford!XM net HMI TRF4G1&Q FORM MIA
.APPROVED BY Ar\TL BOARD OF ArTTRINTS.Fa PI PRISMBm BY Mr DEPiaTM NT OF LOCAL GOVER:MrsT FINANCE IC 4-I.1-r4-1
Gibson County Auditor
11 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N
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 eser for homestead fraud.Homestead fraud caul higher tax bills for all:therefore.
• HEA 1344-2001 requires taxpayers who receise the homestead standard deduction to serity that they are eligible to receise the
benefit and to pnside additional identifying information necessary to allow county goxemment to better monitor homestead
filing.This inhumation will he kept confidential and ran only he 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.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Rose, David/Tammy S
R 113ox 346 C
Ila 1I 47639
9517
David/Tammy S Rose
1370 W 1200 S State Parcel Number Legal Description
Haubstadt IN 47639-8730
26-22-12-300-001.766-024 004-01766-00 PT W SW 12411 .86 AC
11111111 tttt11ttrtllt1t1t1 1talt ltrrlrtllrllr tr ir 1111111 rtt1ttl
x
•
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
Iav-Id Jones lose.
• Address(number and street,city,state,and ZIP code) I— -- I , .-— - 0,S a m e as property eddicv -— - - -
I '370 u J . j a 00 S . /--/cd7�-ac41 1 . `17to
Spouse First Middle Last
tmm� Sbue, ►�DSC
Mailing Address(Number and street,city,state,and ZIP code) 0 Same as property address
1'70 L ). ROOS . P—aLubSkac T?, . 42ta '?
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 1 Signature rx Date
•
eE. ^•n
4 CLAIM FOR HOMESTEAD PROPERTY TAX
s;� -�I i� CREDITISTANDARD DEDUCTION
�:,,� State Fortn Sd73 (R2 / 5-92)
yi. ° . � ' . . `
INSTRUCTIONS: See reverse side lorliling inst�uctions.
/� � ' . � • � - ' ' CFA7iFICATI
FORM YEAR .
' HC70
I(We) \ C�� certify�t�b�hditsi��19_
" ve) oc � as our principal place of residence the fc I ving descri ed real property for which a Homesiead Pmpert . T�t Cfe t i. h e daimed:
1(We) owned ❑ Are buying under coniract . - � JA AI � 7 �n�p
/'VY J U
❑ Have a beneficial interest in the entiry thai is liable for thepmperty tazes on the property and thai owns ihe property or is buying under a mntract.
CONTRACTRECORDED ��
It buyirg on contract, Fee Simple owner's name
Recortler's ottice where Contract is rewrded
Counry TownsNp �
er Legal descnption
-al`l��'o d/-�� /� -��
it any ponion o� the residentiai stmcwre or the iand not exceeding one (i) aae that imrt
oi Ne property uGlizetl to protluce inwme.
Counry
�
tii• /<oco-v.
surmund5 (ha� 5tructure is
PROPERTY OWNED BY CIAIMANT IN
Tawnship Counry
certity the above siatements are Irue, correct and complete.
number a�veet. ciry, state, ZIP code)
ASSESSOR USE ONLY
Land noi exceedinq 7(one) acre immediately �
surrounding resideniial improvemenis.
Oiherland
Total land (line 1 plus line Z�
Dwelling
�Residential improvements
Garage
Other improvemenis
Total improvements (line 4 through line �
Total value (line 3 p6s line � �
1 hereby cenify ihe above is irue, correct, and
complete.
Verifying action - Sgnature ot Autliror
19_Pay19_
Lesser of 7l2 Homestead
Valuation or 52,000
COUNTIES
of Gaimant
n.rn�. S •
TRUETAX I ASSESSED
VALUE VALUE.
(�l
(2)
(3)
IQ)
(5)
(6)
l�l
18)
Synature of Assessor
$
[o produce income, tlescnbe the use antl portion
NOMESTEAD
VALUE
NON-RESIDENTIAL
VALUE
Date signetl
Date signed
I Sgnature of Audi;or I Date signed I
, •�