Homestead_Koch�� :
CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
� / State Farm 5473 (RS I 10-01)
�µ Pfesaibed by Ihe DepartmeM N Local Govemment Finance
INSTRUCTIONS: See 2verse side for filing instructions.
FORM
HC10
YEAR
� M�e) � cetW�1'�haf�on t�i"e 1st day of March, 20_
I(We) occupied as our principal place of residence the (ollowing described eal p perty for which a Homestead ProperlyiT�c CrediYis heieby daimed:
❑ I(We) owned ❑ Are buying under cont2ct � i
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:Have a benefidal interest in the entity ihat is liable tor Me property taxes on Ne property and fhat�owns She�property or �s burng under a contraU.
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If buy4g m canVad, Fee Simde ownefs name
Recorde�s ofice whera oontrad is recorded
RecoM number .�Page
TamshiV T ing . . �p�y, fpynsyt� �
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ar ber T.�„ L de �_/J Isthepm ' queslion: .
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propeRy ❑ MoWleHOmop.Qbf.f-�.
H eny poNm ol therz�reysji�denllel stru�cWreq or Ne d not esceeding ona (1 j ace Net immediatey wrtounds th t sLVCWre is used W qotluce income. tlesrriba Me une and portbn
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STATE FOIS.�153X+�` (R3/LIO)
APPRC'/FD BY STATE BOARD OF ACCOU�TS, 3009
TRE.�SURER F00.\f TS-IA
PRESCRIBFD BY i}iE DFPARTAfE�T OF IACAL CA�'F.R.\'\(E\T Fl\A\CE IC61.1 �?-8.1
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[ndividuals and married couples are limited to one homestead standard deduction. As the receipt of this
��eduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
�causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestcad
standard deduction to verify that they are eligible to receive the benefit and to provide additional identif}'ing
information necessary to allow county government to better monitor homestead Tilings. This information
���ill be kept confideotial and can only be accessed by authorized county officials. The Department of Local
Go��erument Fivance will use this information to create tools that will help county offcials eliminate
homestead fraud.
;��5' � � � ..� � .� � � ,K :;o � �
Tomaver\am< procem'Addms SuttPartel\umber LeealDescrintian:
Darrell Koch CR 3005 26-1 I-27-400-004.176-027 � Pl' UE SE 27-2-1 I 5.5085 AC
PRINCETON IN 47670 .
Comp(ete and return to: �����������D���m�0�������m�p0����.�����������Q
GBSON COUNTY AUDITOR, 101 N�'iAliv PRiNCr.Tt7i� i\ 4ibi0
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F'vst AtiCCIe � last
e e...�LC� � a �,J �5 �Z . Li/
manvq ,waess,�wnoe� ene ,veet ary, s�a�e eM TiP coda, � �
��� ProoeM aaEress
o2a'�3a' ��3� o S� .��,rr.-,� ' � 7� zo
Satial Semiry NwMar (tast 5 tliB�u) DrivMS LicroselSW,e ID NumEer past 5 d18��I �f �� (0��� Spetily vf P2h 4 D¢IOw)
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vsi Mioala ' last
Mailvq AECress (nwn0er anE 5Vee1, dry, sta�e eiM 21P cotle) �$ama ae property atlCrax+
Sodal Seauity NwiEer (US� 5 d8ib1 OmeYS licansal$tata ID NianEar (last 5 tlig14) �e 0� (oleasa spetity in Part a p¢Ipw)
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Each undersigned certifies, under penalty of perjury, that lhe above and foregoing information is true antl wrtect and thai he or she is eligiole to receive�tne
homestead standard deduIXion on this property. Each undersigned also understands that, by claiming additional homesiead deductions unlawfully, he or
she may be liable for back taxes and substantial financial penalties. � �
Owner 1 Siq�uNe Date Telaplqne -
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$pouse $iqna5ae Oata Teleplwne -
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