Homestead_Fetcher SIAM FORM!rv+IR:/YN1 THE SUREA RAM ZIA
ArrRm'En BY CT!TE BOARD OF AM't cts,.,e PIIISMarD BY TIE DEPARncYT OF l(CAECA'TC'MrxT r B:AA'CE I('11-I.•44.1
Gibson County Auditor
171 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples are limited to one homestead,aandanl deduction.As the receipt of this deduction becomes
di more beneficial.there is more incentive than escr for homestead fraud.Homestead fraud causes higher in bills for all:therefore.
HEA 134-1-2009 requires taxpayers who receive the homestead standard deduction to verify that they arc eligible to recene the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
filing-.This inturmuion will be kept confidential and can only be accessed by authorized county officials.The Depanment of
Local Gmemment Finance'ill use this infomation to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
—. Fetcher, Adam JNalarie D
6589[250 S
FRANCISCO IN 47649
4817
Adam Fetcher
6589E 250 S State Parcel Number Leal Description
FRANCISCO IN 47649-9060
II III I III I I II II II I III I I I 26-13-29-100-001.611-004 002-01611-00 PT NW NW 2929.892 AC
o
t Tn I uT u l n r n tar n nt ti t t et it t
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
gala"in J 05 C-11 Fetcher
c o d e) --� -�-Sestet a s propem -
6Fe9E 2coS rran65 ( o qN 1176. ` 9
Spouse First Middle s Last
Mailing Address(Number and street,city,state,and ZIP code) actinic� conic u property address
V C-Th °1 E. fir \S\------r- NC . C \ 1 -\. ur-1 .E-°%
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 I Signature Date
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
�� YEAR
CREDIT /STANDARD DEDUCTION Hcto
Stets Form 5173 (R6 14-03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS. See rawvao rich Wr MV seebudfiorm FILED
st�pjzf, t�` s"_�-�` �CERTIF .ICATION/STATEMENT
I Me) ` nkv.AJ J c;e�r� t i ty th- 'a- t - on ta-,- _ s � t 2'y b o?f � r0ch�
,
20 _
1 Me) occupied as our princi I place of residence the following described real property for which a Homestead Property ' -T-aaxx�Credit is hereby claimed:
❑ 1 Me) owned ❑ Are buying under contract �'(a a
iHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prc0iEl §6 ft (6Q T1Yd aPAcL
.- ✓,'�*�"'.� =CONTRACT; RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
s ''?'ASSESSOR SE ON Y=�r
SP,ROP,ERT.Y.DESCRIPTIONa.=_.
County
Tomrship
Taring district (dry, town, township)
P reel ritimber .�
r(v\
e I d
iorL - ` /r� roperty in question:
W Xv
Valuation or S35.D00
VW IiM�r,. ->n
�;_.t$:.�....,.:•.�..
1111
r Real property ❑ Mobile Homo Q.C. 6-f. 1-7)
if any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income. describe the use and porton
of the property utilized to produce income.
fN
Tj.
Date ei ne�
Total land (line 1 plus line 2)
s ''?'ASSESSOR SE ON Y=�r
County
TMnship
County Township
hereby certify the above statements are true, correct and complete.
i atur claimant
raw umber and street, city, state, ZlP code)
rx
s ''?'ASSESSOR SE ON Y=�r
TRUE'TAXrS:
VALUEh
ASSESSED VALUE
ATz100 °h- OFLTV.y3,VALUE�
HOMESTEADx
yi�WON�2ESIDENTIAL s
�ss'rVALUEp?-z•:.
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or S35.D00
VW IiM�r,. ->n
�;_.t$:.�....,.:•.�..
Otherland
(2)
fN
Tj.
Date ei ne�
Total land (line 1 plus line 2)
(3)
.O
'Residential Improvements or Annually'"'
Assessed Mobile I Manufactured Home
Dwelling
Garage,
(4)L-
may- >.� j '��, err F rs ;•r
1= 'O,r,. t.,Fg,
�yam c".t
Other improvements
(6)�'-i
t
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(6)
hereby certify the above is true, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
- YSTANDARD: REDUCTIONAL[
OWANCE` s'- `�+�'r'.- 61a,�?_,gasg'.
20 _Pay 20
Lesser of 112 Homestead
Valuation or S35.D00
§
Signature of Auditor
Date ei ne�
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