Homestead_Gullett (2) I STATE 111101!!'MIR_/aaNl TRREASntLR FORM 79-IA
.APPROVED BY \IE BOARD tit*XI R Sas.gn PREYAIBrn BY nil DEPARTME NTOFLOCLL CAIS'ERYMrN-r FINARCE IC VII-2241
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
• 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 mole incentive than tier for homestead fraud.I lomestead fraud causes higher tat bills for all:therefore.
• HEA 1744--7009 requires to payers who receive the homestead standard deduction to verify that they are eligible to recene the
benefit and to provide additional identifying information necesgry to allow count'goemment to better monitor homestead
fling.This information will he kept confidential and can only be accessed by authorired county officials.The Department of
local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART I: PROPERTY INFORMATION
Taxpayer Name Property Address
Gullett, Jeffrey D ifi ) 6a00Ea-S0s
Id Boa t -
Francisco IN 47649
4553
Jeffrey D Gullett
P 0 Box 1 State Parcel Number Leeal Description
Francisco IN 47649-0001
IllttlltttlllltrTlttllllttlltttllttlll ���� 'Muhl 26-13-19-400-001.469-004 002-01469-00 PT W SE 19295.00 AC
PART 2: TAXPAYER INFORMATION
•
Owner I First Middle � /� � Last
g Address(number and sweet,ct state,and ZIP code) - - -- U property Same as address -
G'a. 26,' /'Ce4c, rew 4/ 7oS?9
/
Spouse First Middle Last
Mailing Address(Number and sweet,city,state,and ZIP code) ❑ Sante as property address
Social Security Number(last 5 digits) Driver's License/State ID Number (last 5 digits) Other(please sputi r in Part 4 below)
Stir
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.
tTvnerl Sign��/E�� �/ ///J / Date
CLAIM FOR HOMESTEAD PROPERTY TAX
'J CREDIT /STANDARD DEDUCTION
r
m
i State Form 5473 (R2 15-92)
INSTRUCTIONS: See reverse side for filing instructions.
r
_ _r - '• CERTfFtCATION STATEMENT :71,"
I (We)
I(We) occupied as o r rinc lace of a idence the following described real property for which a I-
r(We) owned ❑ Are buying under contract
IJ Have a beneficial interest in the entity that is liable for the property taxes on the property and tt t
certify that
FORM YEAR
HC10
March, 19_
hereby claimed: ``��.II
J�IL//
__.. ,�, - i.:..: • . CONTRACT RECORDED.v
If buying on contract, Fee Simple owner's name
GI08r' ' +OtT03
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION - _ ' s, . ;•��.' _ -
County Township Taxing district (city, town, township)
Parcel number Legal description
no a
If any portion of the residential structure or Ne land not exceeding one (1) acre thatlt immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
7
- - - - ?ROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES .
County
Township
County
Township
I hereby certify the above statements are true, correct and complete. Sig re of aimant
ress (number and street, city, state, ZIP code)
I o z4�3
ASSESSOR USE ONLY '-
- - -
TRUE TAX
VALUE
'ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
111
Other land
(2)
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pfrs line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE - ' "
19_Pay 19_
Lesser of 1/2 Homestead
Valuation or S2,000
$
Signature of Auditor
Date signed