Homestead_Will (14) RATE r ORM'AM ix: ■■••1 TarAsttnn FOAM 175
Arnim ED BY RATE DIMIIDOF ATM NIX Tax PRSCRIBED BY MI DEPARTMENT Of LOCAL D(K_R.YMrWT Fn:CE
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 more incentive than eser for homestead fatal.I lomestead fraud causes higher tax bills for all:therefore.
• HEA 1341-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible in receise the
benefit and to provide additional identifyim_ information neRSSan-to allow county government to better monitor homestead
filings.This information will be kept confidential and ran only be accessed by amhnriled county officials.The Depanntem of
Local Government Finance\Sill use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Willi Sandra K — — — — -
R 2 Box I Ibh
Ilaubstadi IN 47639
11049
Sandra K Will
1521E Warrenton Rd State Parcel Number Legal Description
Haubstadt IN 47639-7943
II VIII III VIII rr FIIt IFI I,I'FFI IFI i,,IFF IFr II i,,IFI FFt II iI iIiI
26-23-16-300-001.653-024 004-01653-00 PT NW SW 164101.20 AC
aX D-9
•
PART 2:TAXPAYER INFORMATION
Owner 1 First Middle - Last
1111112 Address(number and street.city,state,and ZIP code) a as property address — -, - - —
15Z\ tasc \Alarre.r�lor T HFID sV t ni 41103c1
Spouse First Middle Last
Mailing Address(Number and street city,stale,and Zit'code) ❑ Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
sus
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.
Own r I Signature Date
`Art* � CLAIM FOR HOMESTEAD PROPERTY TAX
''4-"' � CREDIT/STANDARD DEDUCTION
` y State Fwm 5473 (RS / 10-01)
��° Prescnbed by the Depadment of Local Govemment Finance
INSTRUCTIONS: See reverse side /or filing inswctions.
�='i;` �.��'.�. =?° . , ._� .; -:-.. -,. :: :, - . . .CERTIFICATI
STAIEMENT' .
� FO IJ YEAR i
C 0�
JUL � 9
r
I(VJe) �C.J,�i/!( (�/,/�J.,p, /`, (.�J L/ � certify that on the tst day of March, 20_
I�) occupied as our principal place of residence the following descnbed real property for which a Homestead Property T�c Credit is hereby Gaimed:
I(VJe) owned ❑ Are buying under conlract
�Have a beneficial interest in the entity that is liable for ihe property taxes on the property and that owns ihe property or is buying under a contract.
�`._�; tir�:.+'r�'�`'� �����':. -' . i... ,.'CONTRACTRECORDED.:°;�,' - - '
If buying on cantrad. Fee Simple owners name
Remrdeh olfica where conirad is recor0ed Rewrd number Page
r;;: ...F..-.�".. :� � -. � - -'-" �-PROPERTY.DESC IPTIDN.:� ' - o ��•.;°.6• .� rc�. . . z•i .
Counryn .. �" Tavnship T in dislric (city, fown. fownship) _.
�9/35ux.. S �
Parcel number Le I escription • U f}G Is the prop�en-yyy�� question:
� �_'� I�Q � 3' �i� �� � � � (o —�'�� Al Real property ❑ Mobile Homo (I.C. 61.7-I)
If any portion of the residential struclura w the Wnd not exceeding one (1) aue that immediately surrounds that s4utture is used to produce income, describe �he use antl ponion
ot the property utilized ro produce income.
�S3
�i�-�=�:g4p� y°� �` � '�' 'Y � �T� TRUETAX �� �ASSESSED V/LLUE � -HOMESTEAD � � NON RESIDENTIAL - � �
qE ,:.���gy ASSESSORUSEON�Y _� �. - � .y,q[UE; : �AT100Y'OF.T7V � � VALUE� '3�• �` � � �_°VALUE��� ,+�'���-_��
x . u.. ,� ...-r+X_ 3 -
Land not exceeding 1(one) acre immediately = r F��'� � �'- ��,'�,-,^i':=
surroundingresiden[ialimprovements (�) ��� -,- •;�...�,_�-�. ;%r'��.�
,,. , .,,.<_,. _: ..
r, �. , -
Otherland (z) -�:� ,;�;='�c::"�::
`t...�:
Tatal land (line 1 plus line 2) (3)
.,. t '; ,� -:
Dwelling (4) '; ,,��r �.5,� � � ,,.�s��.���; �':
Residential impmvements :� n-Y � x zz �
Gara e �:,?�r�'..,�� r.�� �r�Tr.c�,—�
9 (5) '�a~.c�_�"���"��. fx4��::
Other improvements (6) �� �' >` �•-.
, �ef�:' _
Total improvements (line 4 through line 6) (7)
Tdal value (line 3 pha line n (g�
I hereby certify ihe above is We. corteG, and Signature ot Assessor Date signed
complele.
Veri(ying action - Signa�ure ofNidilor Date signed
20 _ Pay 20 _
Lesser of 1f2 Homestead
Valuation or 56,000
3
e
SgnaWre of Audiia l Dale signed
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