Homestead_York SIMS FORM' eaIR'rw,, T1.ASUlFA FORM TS-IA
Ar1'Rrw'en BY ST ATE S'NRDnrMC/RS%Ts_,nw PRtsAmm BYinr DEPARTS/M.70FLOC AL COVERNNFAT FINANCE ICLI.1-7:-tl
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 ever for homestead fraud.homestead fraud cause higher tat bills for all:therefore.
HEA 1314-2009 requires tatpayers who receive the homestead standard deduction to verify that they are divide to reecho the
benefit and to provide additional identifying information necessary to allow county government to better monitor homestead
tilinps.'Ihis information will he kept confidential and can only he accessed by authorized county officials.The Depanntent of
Local Govmunent Finance will me this information to create tavls that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
_ York, David/Shirley
RI I3ox 66 C
Haubstadt IN 47639
7199
David York
2504 W 1000 S State Parcel Number Legal Description
HAUBSTADT IN 47639-8614
26-18-35-100-001.715-024 004-01715-00 PT SW NW 35 3 11 2.16 AC
to ulIt II nn IIt III nI nI n I I IItI o III Inc I n I I iiI t I
0-27
X
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
g Address(number and street.city,state,and ZIP code) ❑ Same as property address
��0/id /ta 5 / ' & f121,i� 5/7L?7
Spouse, First Middle Last
///X/ e7/ cl Efsrr �oi2 ,lam
Mailing Address(Nu r and street,city',state.and ZIP code) Same as property address
67-07;i1 / io0n 3 /857-2 /77— �47- /74,9
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 Sign, p'0 Date / '
.. 7
•
R, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
SW�e Fwm 5473 (R6I4-03)
Prescribed by the Department of Local Gavemment Finance
INSTRUCTIONS: See reverse side Ior filing insfruclions.
! ,FORM{- �� YEAR
y'—i HCtOfj � 1! �
� k
JUN �3 2004
� (N/e) y` v i: - - - - -�'� i-��--- :,--
certi(y thail�•t�e istdayof Marchp20_
I(We) occupied as our principal place of residence the followi �b real property for which a Homestead Properry T�c Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under wntracl
' Have a benefidal interest in ihe entity that is liable for the property taxes on ihe property and that owns �he property or is buying under a wntract.
If huying on conVad. Fee Sunple ownets name
afice where conVacl is remrAed
Counry
Tovmship
Tating
Record number � Page
�u�i Ux
Parcel num r _ e I s io
� ' � /�%) Ihe properry in queslion:
� v v p�� ���� Real property ❑ Mobile Momo (I.C. bt. f-�
It any portion ol Ne resitlentlal struqure w Ne Wnd not ezceetling one (1) acre Nat immep �alety sunounds Ihat wGUre is usad b produce incame, describe Ne use antl portlon
ot Ihe properry uti'vxA b praduce iMOme. �.�/ n�
(O i�
L �-��3.� ied-a�/. %s-a�y I
�:���� ��"'��s��`��x ���� �TRUETAX�-Y' �ASSESS D VALUE '�HOMESTEAD� }"' NONAESfDENTIAL �h
�-��,��''�ASSESSOR��USE ONLY� _ �,"� � ,�.VALUE��� �'AT.�700%'OFTTV i'�^'°VALUE <'.+.�'�- � a,.� .. .� VALUE �°��"'E`
a�, r,- d 2�?L.4'_�^�' ._�r.=,PY�i:f.��..�,,, id�.+�,__.�. -,a. �.- .l�b#.a -.2s 3Fr�.ssr%,,...t ,. .�.1.:�-z�...�,�;.' _ ic�-'
Land nol exceeding 7(one) aae immediately � r� ,�,��r: ��Y+.��k q`�
surrounding residenlial improvemenfs. (� � 4�', '��'��-�e����,l��:
Other land -1F�����'� �
�Z� :_��:��
7dal land (line 1 plus line 2) (g�
.-a�` �4 a�� �'VA� �S rF'
Dwelling (4) ������.�.-�-�� F�
Residentiel improvements or Mnualty
Assessed Moblle / ManufaGUred Home Garage (5) K�,„3��;� :��a�
��.n�. '� �`K` ` a.w. �s�
.4��-,#�,��-�,�,i
Other improvemenls (g) �±� �:�„� ��
���fZ- �t �'3`�'�,
Tdal improvements (line 4 through line 6) ���
Tctal value (line 3 phs line � (g�
I hereby certi(y �he abOVe IS W e, coved, and Signature otPssessar Date signed
complete.
Vrri(�v�g aclion - Signature of Auditor Dale signed
�r� a�'.�'�� 4_ddmi�'`.Fi�3'o1*�;i'.,��'v.?"�w'�`�'�'STANDARD;DEDUCTION AL'LOWANCEt;�,�`,«"s�u'e ^.'�-a`..�"4�'�F�*c�`a, a!f:� a���3Y�!��'s`'ti�.�'`e>� a�
20 _ Pay 20 _
Lesser of 1/2 Homestead
Veluatron Or 535.000 5
Signature of Audita � Date signed