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Homestead_Shannon SLATE FORM 5)500(U I&10) TREASURER FAIN TS-IA APPROVED BY STATE BOARD OF ALYo5M5.7t04 PRESCRIBED BY THE DEP.IRTMEST OF LACALC.O\fl'MEYT FOtA`10E IC 6112221 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�4{767��1 -more:benefcial,where is more.iattntive than ever.(or homestead fraud.Homestead fraud causes higher tax bills(or all;therefore. F y HEA 1344-2009 cg Tres axpa ers afro recenr he homes cad s andard deduction to verify duF hey are elig ble o receive i e I L yY J'• 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. - APR 0.8 2011. PART 1: PROPERTY INFORMATION C. . • Taxpayer Name Location Address Shannon, James M/Orvietta L - . GIBBON COUNTY AUDITOR,. 5129E 1200 S HAUBSTADT IN 47639 -- — -- 11413 - -- ^ - - -- - — __ -. James M/Orvietta L Shannon I II IIIII_II1IIIIIIIIIII IIII_IIIIIIIIIAIIInll�ll=ll IIIIII i Ili I�I�III�II:Illlll lif 5129E1200S Haubstadt IN 47639-7909 . hl'i'IIII"IIIlI'l"'lllIlIlii ill IIIlllllll,I'lllIlIllll'lIIIII' State Parcel Number Legal Description 26-23-13-200-001.859-024✓PT NE 13 4 10 9.48 AC D-10 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. .._- . MNILAuIr173t1 — - - Cnn—1-1 - First < Middle Last~- ' Mailing Address(number and street.city,state,and ZIP.code) JR Same as property address S! 2. 9 6 /Z0 © 5 # , —e n 5- t 92638 =. Spouse First Middle , Last 0R. v l r /T� Z tS�f,5tu pe 9 � ' Mailing Address(Number and street,city,state,and ZIP code) 2Same as property address S / z9 f IYo S ' I/Av 6Sice;eX:i irc4i� t .7‘3, ` - - . - PART 3: CERTIFICATIbN _ 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 ` i�Ill��t11,1\I\ lNli\ii/1 14tItiliI A ^'n ' , CLAIM FOR HOMESTEAD PROPERTY TAX r -�� � CREDIT/STANDARD DEDUCTION ` � State Fortn 5473 (RS / 10-0t ) ���� Prescribed by Ihe DeDariment of Local Govemment Finance INSTRUCTIONS: See 2verse side lor (ling insfructions. M FORM EAR H�,a b 6� �(We) � rti the 1 st day of March, 20_ I(We) occu ied as our principal place of residence the following described real property for which a Homestead rope y Tac Credit is hereby daimed: ❑ I(VJe) owned ❑ Are buying under contract ge '}p7�'''� �4ave a benefidal interest in the entity �hat is liable for ihe property taxes on the property a�t c�yns�ro9ert4.o�ng under a contraU. � JL��J � "'� If buying on contraa, Fee Simple ownefs name Recordefs ofice whera conVaq is recordetl Counry TwmShip Parcel num6e= � M� Leg e: O If any poAion of Ihe residenUal sWCWre w Ne land not of the property util¢ed tn produce income. -oT3 GIBSON iating aisirict (ciry, town, township) Page I� y�I O I IS �e Pro� ❑ Real pr perty ❑ Mobile Homo (I.C. 6f.7-'� one (7) aae Ihat immediatey wnounds Nat swcture is used to produce income, desuibe Ne use and portion 9 , �l8►�c. 'm � `�'�'I'-'�.�Tr�.�'`x3..`��%'�3� .�£i"3�- -'F � a � - f<<F.. +:se .o -�� ASSESSOR�USE ONLY'� �-� i TRUE TAX i- ASSESSED VALUE �+HOMESTEAD. NON;RESfDENT1AL�"- s ��� �f;, y ,�: -�c� uwte.,ur�e� . _ +^� „��� ��VACUEx�,� '"AT.c100%.OF�TTV� ��'�VALUE� �:'-%'�q'�"�VALUE �a�y:,�` �s'��. Land not exceeding 1(one) acre immediatety ��� ;�fi "�'''�ri`,°+°�,�".-,��',t��<�s* . surrounding residential improvements. (�� _+S�-�'r";�p�v�?�,y��cv�"�'� Other land (2) �'� A �� -. . Rtal land (line 7 plus line 2) (g� Dwelling (4) i -3'���?�.'.�r��f��rt:b Residenlialimprovements � ���^: Garage 5 �. , �'�'"' �s����� ( ) .t����-� � � _^�( ''s",=''"'�C' }= �7i Other improvements (6) � r'-� �.v- �` �"� � �.?3'F-s�� Tctal improvements (line 4 fhrough line 6) (7� Tdal value (line 3 plts line n �g� I hereby certify �he above i5 We, cor�eG, and SignaNre of Asseswr Date signeA complete. Vailying aUion - Signature oflwdiror Date signed �`�.�,s��,:a"���.. F;t:�.a`.�T`�'�-y�y.,,e�-,a-4°.�STANDARU:DEDUCTION�AL' COWAMCE �s�;?i,e��'r��, rrg �".': «"tK,._"�x�'y'�.,`�.%-_"��� 20_Pay20_ Lesser of tY2 Homestead Valuation or $6,000 S Signatura of Auditor Date signed — _ ____—__ _ ___.�_ w—� a a 'w-� �r�