Homestead_Smith (10) slit FORM!!v.,17.2/aoO 17S.MII[Q FORM:5-IA
AIWIT HI BY,EVE B(HRO Of An'r RPT,.Ban PREAAIBIID BY 411E DEPARINfar(K LOCAL GOVERNMr1.T FINANCE It'H.14Yt.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and married couples arc limited to one homestead standard deduction.As the receipt of this deduninn becomes
more beneficial,there is more incentne than eser for homestead fraud Homestead fraud causes higher tag bills for all:therefore.
® HEA 1344-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necessary to allow county government to better monitor horn tead
filings. Ibis information will he kept confidential and can only he accessed by authnriied county officials.The Depanment of
Local Government Finance will we this information to create tools that will help couny officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
_ Taxpayer Name Property Address
Smith, Richard W/Monica
RI Box I 23 C
Ilaubstadt IN 47639
9582 CorreC
Richard W/Monica Smith
12860 S Sunset Dr State Parcel Number Legal Description rb5
Haubstadt IN 47639-8671
26-22-14-300-001.401-024 COUNTRY VIEW EST 10
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Nadd re$5
PART 2: TAXPAYER INFORMATION
Own. First Middle Last
�i Clain O _
J cCC�7° M;i
lg Address(number and street,city.suite.and ZIP code) u Same as property oddzes - -- - _—--
iZ ` 36O S - StA,hsr- Dr► v-c
Spouse First Middle Last
P N)I Co 3 O CI a. Yr) ■-f
Mailing Address(Number and s city, and ZIP code) ume as property address
1 Z g(� - U.n56r Or ., v-2
._
PART 3:CERTIFICATION a'
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.
Own r 1 Signature r Date
,
® '
�� rt�q0
CLAIM FOR HOMESTEAD PROPERTY TAX
iy t CREDIT/STANDARD DEDUCTION
� State Form Sa73 (R2 / 5-92)
S�� :
INSTRUCTIONS: See reverse side lor (iling instructions.
1� � �a�1
!' F . �.� YEAR
HC10
� 8
I(We) Ol�cv—II.�LiC.� � � �. � certify that on the 1 st day of �March, 19_
�We) occupied as our principa� place o, esidence ihe following described real property for which a Homestead Property Tau Credit is hereby daimed:
I(We) owned ❑ Are buying under contract
Have a beneficial interest in the entiry ihat is liable for the property tases on the property and thai owns the property or is buying under a contract.
. . . . : - .-. . , ,. .. CONTRACT RECORDED r . ... i.:. . ; � _ :. ^:is �- �� � .�;,.. -
If buying on contran. Fee Simple owner's name
Recorder's oNice where contract is recortletl pecorC number Page
County
Parcel number
e� ay _
If any portion of
of the property i
Township
Legal description
DESCR�PTION - ��a��f"
7@zing�istricl(ciry, fmvn. rownship)
�
�
�-UUI "
structure or the land not exceeding one (1) aue that immetliatety surmunds that sirudure is used to produce income, describe t�e use antl portion
ice income.
BY CLAIMANT IN OTHER COUNTIES - "� .
Counry
�reby certify the above statements are tme, correct and complete.
Aetlress (number and street ciry, st�. 2IP cade) �,
ASSESSOR USE ONLY TRUE TAX " ASSESSED HOMESTEAD , NON-RESIDENTIAC. .
� . � VAWE VALUE VAWE . VAWE . .
Land not exceeding 7(one) acre immediatey ��° -
surrounding residential improvements. �� �
Other land (2)
'��
Total land (line 7 plus line Z� (3)
Dwellinq (4) • - � '
Residential improvemenis . .
Garage (5) ��
i Other improvements (6) �
Total improvements (line 4 through line � (7)
Total value (line 3 p6s line � (g)
I hereby tertify ihe above is [rue, correCt, and Sgnamre ol Assessor _ Date signed
complete.
Ventyirg aaion - Signature of Auditor Date syne0
� . . . . .. . STANDARD DEDUCTION ALLOWANCE` .:' -' ' " .
19_Pay19_
Lesserof 7/2 Homestead
Valuation or 52.000 $ � '
Sgnature of Auditor � Date signed _
.-.