Homestead_Amos%^��
i � CLAIM FOR HOMESTEAD PROPERTY TAX
i��� CREDITISTANDARD DEDUCTION
�;� � Stae Porm Sa73 (R2 / 5-92)
,_.o
INSTRUCTIONS: See reverse side for liling instruc(ions.
L•' �� � �'���
i t �
_ �.i
�e) ' j 1.�./I/)'1 �� cenity thatGT't�tCaf�9�y�
� occupied as our pn cipal place of residence the fol�owing described real pwperty for which a Homestead Property Tax claimed:
V i(We) owned ❑ Are buyfng under contred
❑ Have a beneLcial in;erest in ihe eMiry ihat is liable for the properry taxes on the propeny and that owns the property or is buying under a wntract.
CONTRACT RECORDED �
If buying on contracl. Fee Simple owner's name
fiecorder's oY.�ce where con;ran is recorded - Recortl number Page
County
number
It a� y�portio� I
of the pmperry i
Coun;y
Township
Lega1 tlescnption
iaure or ihe land not e.ceeding one
income.
PROPERTV DESCRIPTION
Taeing tlis�riCl (City. (o�m,
immetlia,ely 5u« ounds that 5tmcmre Is u5ed ;o produce
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
eby ceniiy lhe above statements are tme. correct and complete.
Atldress �number ano street. ciry, slafe. ZIP moe�
% S� ✓� �'
describe the use arW portion
L
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-HESIDENTIAL
VALUE VALUE VALUE VALUE
ILand not ezceeding 1(one) acre immediately I I I
surmundingresidentialimprovements. (�)
IOtherland (p)
I7otal land (line 1 plus line Z� (3) I
Dwelling I (a) I
Residential improvements
Garage (5)
Other improvemenis (6) I
Total improvements (line 4(hrough lina � I �7) I I
Total value (line 3 p�s line 7� (8) I I
I hereby Certity the above is Vue, CorBCt. and � Signature of Assessor I Date signetl
complete.
�� action - Signa;ure ol Autlilor Date signetl
STANDARD DEDUCTION ALLOWANCE
I79_Pay19_
Lesser of 7l2 Homestead
Valuation or 52.000 S
SignaWre of Autli;or Dare d _("1,�_�
�
7
J
S�, -r.2a�s�S5s�rt3�e.io) TAEASIJItERFORNTS.IA
APP VEDBI'STAiEBOARDOFACCOl7\TS,?009 PRESCRIOEOBYTHEDEPAAiT¢\TOfLOCALCA�'ER\:�fE�'TFI.�'A\[EICbI.I�'-B.i
, / � ' / � / . , 1 • , 1 � , �
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
�eduction becomes more beneficial, there is more incenti��e than ever for homestead fraud. Homestead fraud
•causes higher tax 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 allo�r count�� government to better monitor homestead filings. This information
�vill be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance will use this informatioo to create tools that will help county officials eliminate
6omestead fraud.
� � � � � � .�-, x:`.
TnoarerName Prooern�Address SplePercelNumber LeealDescrintion:
DOn31d R Am05 435 E OLD PETERSBURG RD 26-Oi31d00-000.668-027 PT NE 31 I 10 23i AC
PRINCETON IN 47670 C_�
Con�plele aud teturn to: IIII�IIIIO� � I�Q C'���������i � m���� ���� ��� �������
GIBSON COUNTI' AUDITOR, 101 N MAIN PRINCETON IN 47670
� •
O.mer 1 Firsl Mi001a Last
Ui✓/�/�� / � ii
Yvq Atltlress (numoer aM s:reet, tiry, sute antl ZIP mtle) �ama as qoperry eCEress
J
Sodal Sevxiry NumEer (last 5 Eigih) Orivels LicensNSU:e ID Number past 5 tligita) �' ONer (O�ease spedty in Pan 4 Oelow)
� �
Spwse First Atiaale �ast
Mailinq Aedrau (nuneer ane meet, cry, sUte antl ZIP coEe) ❑ Seme as prooerty aaeress
Sor]al Sem�ry Nivn�er (last 5 diglb) Drivefs LicensdSlate ID N�moer Qast 5 digl4) �� Olner (peasa sperLy in Pan 4 below)
m
�
Each undersigned certifies, under penalry of perjury, that the above and foregoing information is tme and correct and that he or she is eligible ro 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 penaities.
O.xnar 1 Sipna' `a Date Talephone
/�i�`GG'� /o-a Ll-av�a (��
$pouu Sigeu:ws Date Tsleptwne
� �
� 1 1 � � ' � ':: -s*
�
. � ^LI
C' .1 fM�». .�i
vv
GIBSON COUNTY AUDITOR