Homestead_Brames STMS FORM!)`FFIR_I twl TREASVUa rWKM IS-IA
APrR(T'ED BYSI(rE NWT)OF MYYIATS._nr PIEGTJam BY ME DEPAREMEYT(FLOCAL COVELVMR.T FINANCE M4.1.1-5_4.1
Gibson County Auditor
101 N Main IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
PRINCETON IN 47670 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_Homestead fraud causes higher tax bills for all;therefore.
• HEA 1344-2000 requires taxpayers who receive the homestead standard deduction to verify that they are eligible to receive the
benefit and to provide additional identifyine information necessary 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 Department of
Local Government Finance will use this information to create tools that will help county officials eliminate homestead fraud.
PART 1: PROPERTY INFORMATION
Taxpayer Name Property Address
Brames, Dale A
R4 I3o.x 108 )
Princeton IN 47670 mV'
380 �/,
Dale -
A Brames
302 S White Church Rd State Parcel Number Leflal Description
PRINCETON IN 47670-8116 X 26-11-11-300-004.036-028 01R-04036-00 PT SW 112111.2056 AC
It�n��n t�tl�n�ur���nt�ulnn��ur�lr��n ll
111..1.1
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
Opl� a nn Ri; E5
—
4111p Address(number and street.city.state,and ZIP code) ® Same as property address
oa s \-1-tC R°AA
Spouse First Middle Last
Mailing Address(Number and street,city,state,and ZIP cock) Same as property address
Social Security Number(last 5 digits) Drivels License/State ID Number (last 5 digits) Other(please specify in Pan 4 below)
Srs
PART.3:CERTIFICATION _.
Each undersigned certifies,under penalty of perjury,that the above and foregoing information is true 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.
Owner I Signature Date
0
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Farm 5473 (R614-03)
Presuibed by ihe Department of Loral Govemment Financa
INS7RUCTIONS: See /everse side /wllirg insfi�Uions.
FORM /�(� YEAR
HC10 ��
I (We) t�{hat o�th�ltla�e4f�AanCr,20_
certi
I(We) occu 'e as our principal place oi residence Ihe following described real property (or which a Homeslead Propert Tac Credit is her by daimed:
(V✓e) owned ❑!ve buying under contract �P R 1 7 200�
, Have a benefidal interest in the entiry ihat is liable for the property taxes on the property and that owns the property or is buying under a contraU.
if buying on conirad. Fee Simple owners name
Reco(defs olfice whwe conVaq is recorded
Counry
Tuvnship
Tating disiritl
Rewrd number � Page
I� �- Q� I Legal description Is the m
p perty in question:
property ❑ MobUe Hwno (I.C. 67.7-7)
,ntial sWCture w Ihe land not eaceetling one (1) aue ihat immetliately wrrounds that sWCWre is used lo Droduce income, tlescribe ihe use antl portion
produce income.
� ��i����.�r_ �.�'°�"-�a`��itT"`4��`<'�� :°�'��`�r'+Y�`STAN�ARU:DEDUCTION'AL'LOWANCEt�- '-,",. v „�..tu�-.� * -r - :� �.�a'.-:..-�,
-sY3a?b'ta..a.4�w;.iz�:.va. .:`�1.�'�`7�.&�.� .sa:?3-.��
20 _ Pay 20 _
Lesserd 1/2 Homes;ead
ValuaLOn w 235.000 S
Sgnatura ofAUCilw " Date signed -