Homestead_Patel (3){!f"�yn4
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form Sa73 (R2 / 5-92)
INSTRUCTIONS: See reverse side lor /iling insfructions.
FORM YE�
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�) v_/`vT't�lyil..�(MR�C certity that on the 1 st day of March, 79 q!O
n) occupied as our principal place of residence ihe following described real pmperty for which a Homestead Pmpertv Ta�.^Cr�ed� he�
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I(We) owned ❑ Are buying under contract � - AUDITOR�d�
Have a beneficial interest in the entiry ihai is liable for the propeny t�es on the property and that owns the property or is buying under a contract.
� . . CONTRACTRECORDED
It buying on contracL Fee Simple owner s name � . . . ' � .
Recorder's oHice where contract is recorded Record number Page
Couniy
Pamel number
Legaldescription
PROPERTY
rown. rowns6iP)
If any portion of the residencial strucmre or ihe land not exceeding one (7) acre that immediatety surwunds that structure is used to produce income. describe the use antl portion
o( the pmperty uliiized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
Couniy Township
.eby certity the above siatements are tme, correct and complete.
Address (number arMSbeet. ary, s(are, ZlPcode)
Counry
Signature of Uaimant
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ASSESSOR USE ONLV TFiUE TAX . ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately ,
surrounding resideniial improvemenis. (�) �
Oiherland (p)
Total land (line 7 plus line � (3)
Dwelling (4) �
Residential improvements
Garage (5)
Other improvemenis (6)
Total improvements (line 4 through line � (7)
Total value (line 3 p�s line 7) (g)
I hereby certity the above is true, correct, and Signa;ure ol Assessor Date signed
cromplete.
�Vinq action - Signature of Audi;or Date signed
STATE FORN SJ569 (RZ/8-09)
APPROVED B�' STATE BOARD OF ACCOU\TS, 2W9
I
!iREASURERFOftNTS-IA1 ^
PRFSCRIBEDBYTHEDEPART\IEYfOFLOCALGOVFRYMidIiFINqSCEiC61�L22-8.1 �
Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beueficial, there is more incentive than ever for homestead fraud. Hotrestead fraud
•auses higher tas bills for all; therefore, HEA 1344-2099 requires taxpayers �vho receive the homestead
standard deduction to verify that they are eligible to recei�•e the benetit aud to provide additional identifving
information necessar�� to allow county government to better monitor homestead filings. This information
will be kept confidential and can only be accessed by authorized couuh� officials. The Department of Local
Government Finance will use this iuformatioo to create tools that r��ill help count}• officials eliminate
homestead fraud.
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Taxoner \ame Pronerb'Adtlrtst Slah Parcel Number Leyal DescrinNon:
Ramesh P/ Saneita R Patel � BO% � 83 A 26-0531-400-001.625-02J 006-01625-00 PT N SE 31 1 10
Pnnceron IN 47670 5.6565 AC C-1
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Complete and return !o:
GIBSON COUIVTY AUDITOR 101 N biAIN PRINCETON IN 47670
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p�1 I/ '�J 1 1 FiSt � MiCNe ���� �� La
Madmg Atltlress (�+�g anE sbeel dry. S�ate aM ZIP cotle) � gy�p as propetty aaE�ess
19�2- 1�1 a� pE-rF�����C RD. R�rvc�-�ans �N ��-7E7p
SodalSeamN �� (bzt 5 Eplss) Orlvets �rnnu State ID NurtEa (qst 5 alplb) Sue Olnc (prase speoty in Pmt a Dtlox)
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Spouse Flrst . - .- - " . . MiECIe . . . Last
s° fl r� �lrt- (� �2 P R T�= �
Ma3n9 AEtlress (nwter aM weel ary. sizte anE ZIP catle) � Same az WW�Y atlEress
I q s-� N o L� PE r� R� 13� R �c f2� P��/ �7"oN rN 1-��67 a
Social
Each undersigned certifies, under penalty of perjury, that the above and foregoing informatlon is We and correct and that he or she is eligible to receive the
homestead siandard tleaucfion on this property. Each undersigned also understands that, by Gaiming additional homestead deduclions rmlaw(ully, he or
she may be liable for back taxes and substantiat financial penalties.
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