Homestead_Burleson STATE FORM 53569(RMS-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL CAVERNN1ENt FINANCE IC6-1.1-22-8.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS ''_
•Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
-seduction 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 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.
,,:;:, ,!' ' -' `_ ' PAR I: PROPER V INFORMATION '• :•
Taxuaver Name Property Address State Parcel Number Len(Description:
James E/Brenna Burleson 416 R'GLENDALE ST 26-12-06-303-004.152-028 PARKVIEW 14/15 BLK I
PRINCETON IN 47670
Complete and return to: 1 IMEINI1111E1121111E119130,111110111EPLE
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
fi PART 2: TAXPAYER INFORMATION . •
Owner 1 • First Middle Last
To.yr. e.S Ow.,-- iu /es,71
Matting Address(number and street,city,state and ZIP code) Vol Same as property address
Spouse First Middle Last
8hetinec S e- 6Ur1.66o.1
Mating Address(number add street city,state and ZIP coda) r ' Same as property address
_ _ ..`._ ._�._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 1 S' nature Date
, ,-
FILED
I NOV 7 2012
GIBSON COUNTY AUDITOR
i� :r„E <
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1 16
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
FORM
HC10
YEAR
INSTRUCTIONS: See reverse side !or filing inshuctions. �-"' �� i.- ; � �
� c :(�� �
C TION STATEMENT �" ' '- - `^' -"1�
I(We) certiry thai on the 1st d��t,Ma4ci(, �00
I(VJe upie as our principal place of reside e the following described real property for which a Homestead Property T-8redit is her�y clai�ned:
� (� �
I(VJe) owned ❑ Are buying under contract � �—
ALGU�.i--� ;';��✓��t
❑ Have a beneficial interest in the eniiry that is liable for the property taxes on the property'and that owns the property or7s huyingvnder a�co_niract��-��
CONTRACTRECORDED
If buying on conVact, Fee Simple wmers name
Recortlers office where contract is recorded Recortl number Pa9e
PROPERTY DESCRIP
Counry Township Taxing tl s'ct 'P/t . township)
1
Pa I mbe^ ^ � �/) O k,�(descnp6on
�lJ `kX ��
If an porlion of fhe residential siructure or Ne IaM noi exceetling one (1) acre that immetliately surtourMS ihat swcture is usetl to protluce income, tlescribe Ne use and portion of
the ProOerry utilized to DroOuce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Townsttip
. �
I Signa e of daimant
�ereby certify the above statements are We, correct and complete. £
Address (numb,er \and st ef, ciry, stale, ZIP codeJ
W
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediatety (��
surrounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage� (5)
Other improvements � (6)
Total improvemenis (line 4 fhrough line 6J (7)
Total value (line 3 plus line 7J (8)
I hereby certify the above is true, correct, and Signamre ot nssesor Date signee
complete.
Veritying action - Signature of Autliror Date signea
� STANDARD DEDUCTION ALLOWANCE
79_ Pay 19 _
Lesser of V2 Homestead 5
Valuation or 52.000
Signature of Auditor Date signetl