Homestead_Blackburn (2) %TATE FORM flSa tR2 unl TPE191E@ FORM TS-IA
nrrMA'ED BY STATE t)Uto(KMTVX 1t Yx PRInThD BY THE DEPART/Et-OF LiCAL GOV=RYMFAn Fat'CE IC 4-1.1-E4.1
Gibson County Auditor •
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 Individuals and mauled couples are limited to one homestead standard deduction.As the receipt of this deduction becomes
more beneficial,there is more incentive than e'er for homestead fraud Homestead fraud causes higher tax bills for all:therefore.
HEA 1343-2009 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifying information necesory to allow county government to better monitor homestead
filings.This information will be kept confidential and can only be accessed by authorized county officials.The Depanment of
Local Government Finance will use this information to create tools that will hap county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Blackburn, Donald L Jr/Danette L
420 S Main
Princeton IN 47670
1003
Donald L Blackburn Jr.
420 S Main State Parcel Number Lezal Description
PRINCETON IN 47670-2444
illlllllllI II llll Ill err rrI I I tlr 111ll'III III VIII rrI ill X 26-12-07-304-000.688-028 019-00688-OO WILLIAMS2ND3
This form MUST be returned to County Auditor's office.
Please do NOT send this form back with your tax payment to the county treasurer.
PART 2:TAXPAYER INFORMATION
Owner I First Middle Last
pora■,cY Qe $LACK-3orO , 5r_
•rg Address(number and meet,city,state,and ZIP code) ErSame as property address
Spouse First Middle Last
Dan.e-44-e- a k cK_c3o Tou
Mailing Address(Number and street,city,state,and ZIP code) f JS.ame as property address
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is toe and correct and that he or she is eligible to
receive the homestead standard deduction on this property. Each undersigned also understands that,by claiming additional homestead deductions
unlawfully,he or she may be liable for back taxes and substantial financial penalties.
Own natureI _ Date
•
•
°; . . . -
' CLAIM�FOR HOMESTEAD P.ROPERTY TAX
° CREDIT/STANDARD DEDUCTION
♦ / State Form 5473 (R6l a-03)
' Prascribed by Ne Departrnerrt of Local Govemment Finance
INSTRUCTIONSr See reversa side for filing instiuctions.
— -- "� --- -
FORM YEAR
HC10
� M'8) ��j( U/ � wl/�C- Yi /ll6(�v RQ� �;e�t�//�(��, '�� tf� �98� of March, 20_
I(We) occupied es our prindpal piace of residence the following described real properry for which a Homestead Property T� Credit is hereby daimed:
n I(We) owned ❑ Are buying under contrect �� ��
i-lave e benefidal intarest in the entiry that is liable for the property taxes on the property and that o���gpropOUNTY AUDITOR er a convact.
V fJ C;
on contrea, Fea S4nple owners name
Recorders office where
Tovmship
description
woaam
Recard number � Page
(/ ('�j _(,L�io oO�Ly! U J(j'i�;�;ajyy(j(j�x �� ���i o,�Pam ❑ Mobile Home Q.Q G7.7-n
II any portion of Na tesidential strucNte u Me IaM rwt ezcaeding one (1) aae that immediatey wrtounds Nai s c4ura a used lo produca inwme, Eescriba Ue uu and portion
d Me property utlirzed to produce income.
�?�� 4*a"kr'aC,-`"�f �yY,.'...�`,7 .h.i'r°�..�"i'$r�..� 7r:^.s�.ti:.`STANDARD�:DEDUCTION'A�LOWANCEs ._ . .. .. . . ',�-..:. ., . _ .--. � . I
20 _ Pay 20 _
Lesser of 1!2 Homestead
Valuation w $35,000
8
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