Homestead_Sisson (3)I (We)
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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
sma ro�„ sar� �� i sou�
PreaabeC by the Depmtrnent d Loml Gorernnerd Fmm�m
INSTRUCTIONS: See ieverse side /w filing ins6uctions.
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place of r�idence ihe fo9owing de�srnbed rral property tar which a HmiesOead Propelty Tmt Cre6t is heteby daimed:
I aodred U Are buy'vg unda mntract
a benefidal u�Eeres[ m the entiry tliat is liade for the popeAy tmces m Me property arM Mat owns tlie poperty or is buying under a contract
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IF 6uyu�0 om m�bap. Fee Sirt�le ownera reme
f�mdds ot5ce whae mNad is iemdeC Rewd numbe� Pege
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Tomsfup
deaoipdan
NenY PwWn dthe resde,Cial shuchre R iha lad nol mcceednp
d U�e papaAy �imd Lo ryoAre uxmie.
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T�9 di�r� : mwn. fo�wuldP)
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� b Ihe popary n question:
_ pop
ore (1) aae tlml inmed�ely amae� tl�at is used
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LJ MahibHane(LC.61.1-� �
produoe iiaome. des�fie U�a �ae arid portion
� � �f � r � ' � � � i sc5'f�� »'+ 7RUE TA7C ij' �� � VALUE kO1�,.STEAD� �. r ytYr��NON�RESiD6lilAL�rj��'�r
�� ,: � u+ASSESSOR USE ONLY .�< ' '�i � � .. � K�
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Land rwt e�ng 1(one) aae irm�edahiy ," �+ n��!�. ��yVro j� r�. �;i� .rtY t' ��?'
s�a�ae�d'vg residential irtqxovemenis. (�� 't ��`� +.�v%z..a�S'. �'F' i�:?.'�j�,' �,�.�"'��i4�
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Otherland (Z) '��',; :�.�:i�ik.;ti;;i'�f'�i
Tdal land (Ikre 1 pha 6�e � (3)
'y � k M *t 1''�vd.2i• e
DMePng (4) �'tr ft�T�f�"4 �t aW-z�-.ka �/�`V�'�'!
Resdential'vnprwenentsorMmialy " rz�'���'�:*r'S,�r^b�;;�.' � .{,'e
AssesSed Alod7e / Marnt'achrBd F10rtiB �, y rc .rf,�a j�y_ r�� � � rw�
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T�al'unp�ovemerrls (fere ! NuotgA Bne 6) �7�
Tcfal value (I'ure 3 phs Gne n (g)
I hafeby certiiy tl�e ehove's true, cro�reU. and si�ae arnseassar Dah sgied
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2b _ Pey 20 _
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v�em o� s3s,000 s
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SJATiOR.\1'S1569(N18-10) ' TAEASURERFOR\ITS-I.i
APPRO\'ED BY STATE 80ARD OF ACCOIIhTS, 2009 PRESCRIBED BY i}1E DEPARi1.fE\T OF LOCAL W\'EA�?f=�T FINAXCE IC61.1 +2-8.1
Indi��iduals and married couples are limited to one homestead standard deduction. As the rv;ceipt of this
�� duction 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 homestead
standard deduction to ��erify that they are eligible to receive the benefit and to provide additional identifying
information necessary to allow count}� government to better monitor homestead filings. This� information
«•ill be kept confidential and can only be accessed by authorized county officials. The Department of Local
Government Finance �ti�ill use this information to create tools that will help county officials eliminate
hnmrcfaad frand �
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Ta�oaver \rme Prooem Addms Su�e Partel Number 4eeal Descrio�ion� �
lefTrey 1 Sisson 1395 S 100 R' 26-11-13300-001.182-027 PT SN' 13 ? I�1 3 AC D-I
PRINCETON M 47670 �
Comp(ete and retutn to: I�II����➢����������I�Iluuu�l�l' Ju�l�lu�l"I�
GIBSON COUNTY AUDITOR, ]0t N MAIN PRINCETON IN 47670 I
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Owner 1 First MiOGIe 1 Last
�Eh'�2 �T �R -SjSSo.�v
Malug Pffiev (mmCOr arq cVeel, �, state anC ZIP wtle) �$ama as property atlErass
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1395 S /DD G/ /�itiucE�o,v /N y767b
SotialSeanry NumDer (lut 5 diB��) Drivefs LicenseState ID Nunoer (Ias15 diglts) sae Qry�¢r(�qgse spedly b Patl 4 pBlo.v)
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Soouae F'vst AtiCGIe � lasc
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Mailvq lbMeu (rnmber aM meet, Pry. stalB enO ZIF cotlB) ��$ynB as poperty aJGBu
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l3cl� �.S /OD P2r,vc��aN /!U y�670
Sadal Seoairy NiaMar (las� 5 tllglb) Driveta licanuJState ID NimEer �bst 5 Eipin) �' ��� IWease spealy in Pan 4 oelow�
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� Eacn untlersi9ned certifies, under penalry of perjury, that the above and foregoing information is true and correa 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 deductlo;is unlawfully, he or
she may be �iable for back taxes and substantial financial penaliies.
Ow�ar 1 Sipfunaa Date Telephme
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DEC 7 2012i j
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GIBSON COUNTY A ��,