Homestead_Brines STATE FORM 53560(U/8-10) 'MEASURER rORM TS-1A
APPROVED BY SATE BOARDer ACCOUNTS,2109 PRESCRIBED BY THE OEPAInOENT OF LOCAL GOvRNMEYTFWANt£ICbl.l-123.1
Gibson County Auditor . IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
101 N. Main Street Individuals and married couples are limited to one homestead standard deduction-As he receipt of this deduction becomes
Princeton, I N 47670 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 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.
9 ' ' PART I: PROPERTY INFORMATION
v\IVoi-V.,) Geneive Taxpayer Name Location Address
Brines, Genei Life Est&Julie J
S� �
C 1 LO`\ r Princeon IN 47670
769
Geneive Brines Life �Jutle°tso� 11111111 M1111111111 M1111111 11111 mil-_iril 1111 1 11 11 111a imi
228 N Race§,.... 014C
Princeton IRIX7670-1822 -
IlIIl'illy'1111I0 !I'IIIIIIIlllFllil'll'It1ll1llllll1lll13ttll State Parcel Number Legal Description '
26-12-07-203-000.246-028 ° NS LOT`1 PT R2
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.
'AYPAYER INFORMATION '
Owl First Middle .. "bast
� ene )t ye brines
Mailing Address(number an4aec rees,city.stale,and ZIP code) ❑ Same as property address
�g s KJ sy- Pr;nc_&+a XV - f7I7D
}
Spe®e First Middle Last
�� l, e S Bh'nes .
L xwnag t.ttuntrr ado swat"-, _
nllty:,., IS.�L.'.:';�l:U':_.. _a'°..c-r'ay pr�Pe:?:'rddee° _.��� r
or;VerS..l iO T* C c ......... r"'� �1 . .
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 fmancial penalties.
Own Signature Date Telephone l/ (/
� ` 3.0
)silo .lure II.te Telephone
i
- PART 4: ADDITIONAL INFORMATION ); • -
/ FOHM ML 10 1979
HeSCriGed By Sute Bwrd ol Ta. Cammiuioncrs
To Be PiIM in DuD���h
CLAIM FOA HOMESTEAU PROPERTY TAX CAEDIT FOR YEAR 19 '��
✓
n SEE BACK FOR FILING INSTRUCTIONS p�q- o oa y b � 00
I, (We) �"" "`^""" � certify that on the 1st day of
Q� 3rch, 19 8o I, (We) occupied as our principal pl e of resid ce the following described real property for
�nich a Homestead Property Tax Credit is hereby being claimed:
I, (We) ❑ owned
❑ are buying under contract
❑ have a beneficial interest in the taxpayer
Property Description in ,� County �R�-�'� Township
Taxing District (6ky-Town, TownsHFp): �i`r,c-K�-e�A.
Parcel Number or legal description shown on tax statement:
�
7% .S /.e �2 /,3.t .
If buying on contract: Owners name ��� �""ae owner�
Contract recorded in Recorders Office - Record No. Page
If any portion of the residential structure or the land, not ezceeding one (1) acre that immediately surrounds that
structure is used to produce income, describe the use and portion of the property utilized to produce income
Any other counties in which individual owns or is buying real property:
I hereby certify the above statement is true, correct and complete.
County
Township
���¢ ����
Individual either owns or is buying under a contract that provides he is to pay the property taxes
on the residence, or has a beneficial interest in the taxpayer.
- FOR ASSESSOR'S USE ONLY
Land not exceeding 1(one) acre immediately
surrounding residential improvements
T�otal Land � +°��
Residential Improvemen�AR 7 �93�
�
� AUD�
Other Improvements �
Dwelling
Garage
Total
Total Improvements - Line (6) plus (7) equals (8)
I`eby certity the above is true. correct, and complete.
Signalure of Assessor
True Cash Assessed Homestead
Value Valuation Valuation
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Approved: /_1��/ 1� Date: �— 7—�