Homestead_Martin (2)STATEFO(tWiJ569(AI/A-10) . TREASURERFORMTS-IA
AFPAOVFD BY 57ATE BOARD OF ACCOU\TS, 2009 PRESCRIBF� BY iHE DFPA0.7T1E\i OF IACAL GOl'ER\:AE�T Fl\A.10E I[bl.1-22-8.1
Individuals and married couples are limited to one homestead standard deduction. As the i eceipt of this
��eduction becomes more beneficial, there is more incentive than ever for homestead fraud. Homestead fraud
•tauses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who recei��e the homestead
standard deduction to verify that they are eligible to receive the benefit and to provide additiiinal identifying
information necessary to allow county government to better monitor homestead filings. This informatioo
will be kept confidential and cau only be accessed by authorized county of5cials. The Depan:`ment of Local
Go��ernmeot Finance will use this information to create tools that will help county officials eliminate
homestead fraud. i
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Taxna�rrSame prooemAddress StateParcelNumber yeealDacrinfin��
Marvin 1 Manin 4146 N' SPLIT RAIL LN 26-I I-09-300-003.897-027 M C ROBER'f5 OLD OWENSVILLE
PRINCEI'ON IDJ 47670 RD 13 P�17
. Cnnenlefe and rerur„ !c: -
im�imu��uuom�auoma�u�QU�uu�uum�i�u�u�i�
GIBSON COUNTY AUDITOR, t01 N MAIN PRINCETON IN 47670
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Qmer 1 Firsl MiEdie � last
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Manvg Aaaress 1�+�� ��ea4 a�Y. srote antl ZIP coee) � Seme as yoperty etlereu I
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Soual Seaairy Nunber (last 5 digin) OrivaYS l'irensel5taro ID Nurtiner (last 5 Elglts) ��• o� IWease specEy �n ?an a peiow�
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MaiWg Atltlress (nv`War antl riee� ary. sute anC 21P mEe) � Same as proDerty a0aress
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Sodal Seauiry NimDar (last S diginl Drrve�s LicensNStY,e ID NumDer (last 5 Eigits) �°' �� (d�� s�Y �.P� <���')
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Each undereigned certifies, under penzlry of perjury, thzt the above and foregoing information is true and cortect 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 (or back tazes and substantial financial penalties. �
Pwnx 1 SigeuMe -� Dale Teieyane
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CLAIM FOR HOMESTEAD PROPERTYTAX
CREDITISTANDARD DEDUCTION
Stete Fortn 5473 (R6 / 4-03)
PresaiCCd by Ne Departrnerrt of Lxal Govemment Finance
INSTRUCT10N5: See raverse side hx fiGng inshuc8'w,s.
_ _ �'�
�'FORM YEAR
HrC 10
JUN 0 9 2006
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��e> certiCi IOJ V� � V?.644� RL�r9a2o
,I�(WQe) occupied as our principal place of resid the following described real property for which a Homestead Property Tac Credit is hereby daimed:
I/J—I (VJe) owned ❑ Are buying under wnlract
' Have a benefidal interest in Ihe entity that is liable for the property taxes on Ihe property and that owns ihe property or is buying under a conVact.
II buying on conVad, Fee Simpie ownefs name
Recordels oifica where cantraq is recwded
County
Tamship
Ihe
If any ponion ol Ne residentlal sWCture w Ne land not eaceeding one (1) aae that immeAiately sunounds that
of the property utilaetl to produca income.
County
Twvnship
I hereby certify_ihe above sWtements are We, cortecl and wmplete.
ciry,
(
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Rewrd number
fownship)
Page
in queslion:
�ieal property ❑ MaWla Homo (/.C. 61.1-n
lura is used to produce income, describa Ne use and portion
To.vnship
`��,.�''Y'�����" .:;'l��i�:a`�5�;'St��.�..��`sti'STANDARD_:DEDUCTION'ALCOWANCE;;`_`�'���";,`�',..�2,�'.°v'.-�-"'iti�m-��'.�.''�'�`�"'�._�i�'`,.o-�sl'��.-�
20_Pay20_
Le;ser of 1l2 Homestead
vauauon w 535.000 5
Signature oflwdhw " Date signetl