Homestead_Simpson •
SIMI FOR'J iW,Rn'-tut IRASUL YMYiS-IA.
APNIOcn BY calE 3r1\RD OFN.I.(a Nit.Yao rarsruerai BY nu.D(PARIMLtT OF LOC.rovues"WNT FL' 5 tK'e-1.l.t4,1 j
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
I
Princeton. N 47670 more beneficial.there is more ices-name than ever for homestead fraud.Homestead fraud ea:Fes higher tax bill:for all:therefore,
ti, FILED HEA 1344-7009 requires taxpayers who receive the homestead standard deduction to\erify that they are eligible to receive the
benefit and to provide additional identifying mtlumauon necessary to allow county government to better monitor homestead
filings.This information will be kept confidential and can only be accessed b'authorized counts-officials.The Department of
Local Goverment Finance will use this information to create tools that will help county officials eliminate homestead fraud.
MAY 9 2012 PART I: PROPERTY INFORMATION•
Taxpayer Name Location Address
Simpson, Jerry/Mary Jacqueline
5106 E SR 68
GIBSON COUNTY AUDITOR HAUBSTAD7 IN 47639
10899
o Jerry/Mary Jacqueline Simpson Ii 100111 OI110111011111101011l11111_Ill Bill ii 11 11 11 111111][Ill 1111
5106ESR68
HaubstadtIN 47639
State Parcel Number Legal Description
26-23-01-400-000.923-024 PT W E 1410 6.253 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.
-- tee. . . . _, _ - - _.PART-2..T XPAYER.INFORMATION__-_- . ,______ _-:_. . - —.---_,_._ . _. - a_
er First Middle Last
Py
-. Lee S", mpson/
Mailing Add s Inn..r and street,city,s.:e.and ZIP code) Igl Same as pr4eny address
a l 06 e SR 6? RA-t-Lb s-fJ-/- ;lit c 77 ‘3
Spouse First Middle Last
Irfn-(z.y Jr4Lq LC.F// n/ C Si Ai Sd /�/
Mailing Address(Number and street,city,stale.and ZIP code)) b Ia Same asp perty address
�/O 6o - SR log' ¢d9-teal5/ [N, q ,771.0 55 9
• 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 financial penalties.
Owner I ignamre i) Date
•
wwA nc io iem
AescriDeO By State Board of Ta. Cammissioners
To & FileE in Dupliwte
CLAIM FOR HOMESTEAD PAOPEHTY TAX CREDIT FOR YEAR 19 � 9
SEE BACK FOR FILING INSTRUCTIONS
�(We) '� certify that on the 1st day of
arch, 19 � I, ( e) occupie s our pri cipal place o esidence the following described real property for
wh' h a Homestead Property Tax Credit is hereby being claimed:
I, (We - owned DD� ^oOCi� �`��
� are buying under contract l /!
❑ have a beneficial interest in the taxpayer��_�3�� �-QOO. 9u3.3-4�r
Property Description in �-�-�-°-^^ County Township
Taxing District (City, Town, ownshi ): ��--r+--�
Parcel Number . or legal des�iption hown on tax statem�� ��
�� . c�J 2. G° �z /- `f -/ o �!'
If buying on contract: Owners nam
Contract recorded in Recorders Office - Record
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 portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property: County Township
�hereby certify the above stateme t is true, correct and complete.
- � � 5�7G 3
LSign re Svee� noaress � Ci�y. caie ana Zip Coae '
,
(
ivi ual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY -
Land not exceeding 1(one) acre immediately
surrounding residential improvements
Other Land � � � � �
Total Land
Residential Improvemenls Dwelling
'�'iJ % !9•'�
�`'�' 2' Garage
Total
Other Improvements � �
Tr�' Improvements - Lin �6) plus (7) �`��j��8)
���by certity e above is true. correct. and complete.
�_ � �� � `
Signamre ol Assessor
True Cash
Value
(i) � o 0
(2) �-�
(3) L-�=O
�4> a 7 9 7 0
(5) -
(6) a �97°
(�)
�8� a�9�o
- ACTION BY AUDITOR -
Assessed
Valuation
� %o
Homestead
Valuation
/70
�—�-�� �
� 3 3.�
�-��-�9
oate
Date: � ' Z�� 7 °/