Homestead_Brewer STATE FORM 53569(R3r310) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT,'FINANCE IC6-1.1 22-S.I
0 °' ° llMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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
.auses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead
dard deduction to verify that they are eligible to receive the benefit and to provide additional identifying
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.
PA'TI: PR•PE' Y INFO'MATION
Taxpayer Name Property Address State Parcel Number Legal Description:
Michael W Rm..cE ' 410 N RACE ST 2612-07-200-002.869-023 NS LOT 3 PT 122
- �'e nr' L. e,rewer PRINCETONIN 47670
Complete and return to: I®IIDll1i11D]DI111111]01111 1111111111111 rlrl �® MO
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
. PART 2:TAXPAYER INFORMATION _ •
Owner 1 First Middle Last
.iennitc,r L�rr� �c-ec3e-lr
Mailing Address(number and street,city.state and ZIP code) I s' y‘me as poverty address
VI
.
'h1(/ /^,�+ First Middle Last
Y //
•
Mailing Address(number and street,city,state and ZIP code) Same as puberty address
Social Security Number(last 5 digits) Drivers License/State ID Number(last 5 digits) sae Other(please specify in Pan 4 below)
• PART 3:'CERTIFICA'PION.
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
1 V
. PART 4: ADDITIONAL INFORMATION
FIL E
OIOSON Count I YY AUOOIITO:
1
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
Stete Farm 5473 (R611-03)
Presafbed by tM Deperhnmrt d Lxal GovanmeM Finance
INSTRUCTIONS: See rew+a� a6do b fYrp iubuc0ont
- .., ;; ,�i
��:.
� I 11�
��e) � " GIBSON COUNi T Au�""•'
certify that on ihe tst day o( March, 20_
I(We) occupi as our principal place ( esidence fh following described real property for which a Homestead Property T�c Credit is hereby daimed:
❑ I(We) owned ❑!ve buying under wntract
� Have a benefidal interest in ihe entiry that is liable for the property taxes on ihe property and that owns lhe properry or is buying under a contraU.
I( buyinq on conUact, Fee Simple ownefs name
Remrdefs ofice where conVad is recorded
tn,'_sa—'�:: (f�� ,rt-^^.}-"°- —5-y
f3..<..��F.FtE�.�Fb2:xt�' ��
County � � Tamship
H any portion ol the residentlat sW cWre w the land
of 1he property utilized b protluce inwme.
County
) acre that
I hereby certi(y ihe above sfatements are We, wrrect and complete.
County
(ciry, rown,
Is Ihe
Rewrd numEer � Page
pro i question_
Real property ❑ Mobile Homo p.C. 6f.7-7)
that s cture is used to produce income, desuibe the use and portlon
'�u 1I1J �� t K�i(��i/Pcode) �r11 Y T"Sl IYi, IN y��n� �/ v I
'�x�''_'-��R, �v�ay,e�.'i!� _��?`'�-2r`��c��.�-.STANDARD;'OEDUCTION'ALCOWANCE}�."�,:ik �4?::�'Y-F�:� + �..`��.�i�:-���e'
�������`._ ..
20_Pay20_
Lesser W 1/2 Homestead �
vauanon a 535.000
SignaWre otPUtlita " Date signeA