Homestead_Lustfeldt_ — ..
�� � '' CLAIM:FOR.HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
ti Stata Fortn Sa73 (R614-03)
' Prescribed by Ne Departrne`rt of local Govemment Finanw
� INSTRUCTIONS: See /averse side fir (ling instructions.
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MAY 0 4 2005
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�(WB) certify that d5 Ui�day oif�arch, 20_
I(We) ocwpied as our prindpal place of residence Ne following described real perty for which a Homestea��1 Z2AQJddE1s419�aimed:
�(VJe) owned ❑ !ve buying under contraci
ave a benefidal interest in the entiry that is liable tor the property taxes on Ne properry and Nat owns Ne property or is buying under a conVact.
If Wying on conVact, Fee Simpla awnars name
Recorders ofFce whera conVact is recwded
County
Tovnship
Rewrd number � Page
Orl°�=" o��aa -�G I U a'�L 3' .�LC+' AY_.C/U d I Is the vmPe�ty �n _Geaesti on:e -
) i� 0 C nY ❑ MobOe Home Q.Q 6-f.7-n
I( any portion of the tesidmtlal structure w the land no ceading ona (1) aae that immediatety surtounds that s cture is used lo produce income, dascribe Ne use and portion
of the property Wlized W produce inwme.
-r xi�i''i'�}r�'��`�'` f���` 41�'�, *�`�'4� � TRUE TAXe��"��„+ ASSESSED VALUE t a HOMESTEAD y'�" a�NON�RESIDENTIALT' t`
��,,;,p�.� �ASSESSOR USE'ONLY=��{���,� � ,�� t VALUE+� `� � °-� , VALUEY`i�,�5 `��
j dy � r -,-� �, '� V/LLUE tAT-100%OFTTVcE.-+�: '�, �. * �v+ �'+
+,.. ��3Fx .UP,.::,+s.Y3!..� fr».[ aiv. 1�-YI^�'e.... FL ..-_. __ . .�: ..5 .,J'a_.1_ .�.hi !'!� a.. _.... _. . _::<
Land not exceeding 1(one) acre�immediatety rxu��`^��' -,,;,;.F�.*�.�.,�r`e§- �`r
surtoundingrasidentialimprovements. ��� _,``-� ` `_;�:� w��r,«,,� �'Y�
- .;.:>�r;t'i::�
'r�,�e �4 �
Oiherland �y� �-. s-_`: �_;s.,:;�:
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Ta[al land (line 1 plus line 2) . �3) '
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� „w�r ,F' -s� x �� .Fn
ResidentlalimprovemantsorMnualty �Iling (4) r�y; �, ,�.Y j a_;� ��
Assessed Mobile / ManufacNred Hwne �� ? �, ;v �? � 3� � �:;'� b
Gaf2ge (j) �i> e r`?F Li�p �;t N,°' y
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OjperimprovemenLS (g� :,�,a:��..�•. `��
s
Trial improvements (line 4 th/ough lirre 6) (7� .
Tatal value (line 3 phs line n �g)
I hereby certify Na above is WB, correct, and � �g�aare of nssessor Data signed
compiata.
Vuiryring allon - SignaNre of Niditrn Date signed
�u°.'.i`, �,��i+-`; �����2-�"x..�`..s'�iT`�i:- ��:,+'sSTANDARD�DEDUCTION'ALLOWANCE . �:a';
� 20 _ Pay 20 _
Lesser of 1!2 Homestead
Valuation w $35,000 S
SignaNre o1PuGiWr Date signed
STATE FDRN 5]369 (R'J809) iRF lSU1tER FORN FS4! 1
APPRO�'ED 9Y' S�ATE BOARD OF ACCOIMS.?009 PRE$[R18ED 8V THE DEPARiM&�T Oi LOfAL GOVER.\ W TT FT.V:CE ICbl.l-'_2 � 1
� o � .d � .. � �. Q �a � 1 � 0 1 � ._O � \'.. q
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. Hoinestead fraud
�•auses higher tax bills for all; therefore, HEA 1344-2099 requires taxpayers ��•ho receive the homestead
: standard deduction to �•erify that they-are eligible to receive the benefit and to provide additimial identifying
; iuformation necessary to allo��� county government to better monitor homestead filings. This information
�r�ill be kept contidential and cau onlv be accessed by authorized couuty officials. The Departruent of Local
•' �'Government Finance �vill use this iuformation to create tools t6at ���ill help county officials`eliminate
homestead fraud.
Tamaver \ame
Austin Lustfeld[
Comp(ete and return !o:
a.,,g i
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rer ro•� s
ProoerfvAddrns Shfe Parcel \umber Le¢al Des<rioHonr
R2 Boz 21 I 26-12-16-101-001.522-02� 006-01522-00 G/RIGHT SUB DN 5
Printtron IN 47670 .I
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GIBSON COUN7'1' AUDITOR, 101 N�1AIN PRINCETON IN 47670 ,
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First
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Eadl under5ignetl certifieS, untler penalry of perjury, that �he abOVe antl foregofng infortna�on fs we antl Correct and V1at he or she fs el gfble to recerve t
homestead standard deduction on this property. Each undersi9ned also understands thal, by Gaiming additional homestead deductlons unlaw(ully, he or
she may be Iiable for badc ta�ces and substantial finandal penalties. '
Owwf 1 Sigu�ue
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