Homestead_Dill (5)art�3 q CLAIM FOR HOMESTEAD PROPERTY TAX
i���� CREDIT/STANDARD DEDUCTION
�.. ,�q .,r State Form 5a73 (R2 / 5�92) �
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INSTRUCTIONS: See ieverse side /orlilirrg insbuctions.
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I(We) [1� _�! �/ l�y certify ihat on ihe 1 si day of March. 79
's) o � s o � r'ucipaFpleeeof r nce the following described real proRerty for which a Homesiead Propeny Tax Credit is hereby claimed:
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�We) owned Are buying nder conirac� �v �� _
❑ Have a beneficial interest in the entiry that is liable for the propeny tar�s on ihe property and thai owns ihe property or is buying under a contraci.
' � � � � CONTRACTRECORDED � ' � � � �
If buyirg on ContraU. Fee Simple owner'S name � . '
Recorder's oHice where contract is remrded pecord number Page
Counry
Parcel
J/ / —liLaJ(
It any portion ot Ihe resid
ot the pmperty utilizetl to
Township
Legal
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simcture orihela�M not
�ce income.
PROPERTY DESCRIPTION
' Tacing distnct (city, fown, fownship)
one (7) acre that i�fietliarety surrounds Mat strucmre is usetl to produce income, describe the use and portion
PROPERTV OWNED BY CLAIMAM IN OTHER COUNTIES -
County TownShip Counry Township
eby certify ihe above statemenis are Irue, correci and complete. Si namre ot ciaimam �
dress (numberandstreet ciry. sta(e. ZlPCOtle)
ASSESSOR USE ONLY - TRUE TAX ASSESSED �HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE .
Land nol exceeding t(one) acre immedialely
surrounding residential improvements. (�) -
Oiherland (p)
Total tand (line 7 plus line Z� (3)
Dwelling (4) I � � ..
Residential improvements
Garage (g� �
Other improvements (6) � -
Total improvements (line 4 through line � (7)
7otat value (line 3 p�s line 7� (g)
I hereby certify lhe above is [rue, corrett, and Siqnature of Assessor Date signetl
complete.
Verirying aciion - Signamre of Audimr Dare signed
- � � � STANDARD DEDUCTION ALLOWANCE
79_Pay79_ .
Lesser of 1/2 Homestead
Valuation or 52.000 S
Signature of Auditor . Date signed
SfATE FOIN153569 (R.'1&09) iAFASi/RER FOR.N TSIAI
MPftO\'ED BY STAiE BOARD OF ACCOUYiS, 2009 PRF_SCRIBED BY TF� DEPMP¢.Yi OF LOC.LL fAtlFR10¢Nf FI�A�CE IC61.1-22-A.I
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
deduction becomes more beneficial, there is more incenti��e thau ever for homestead fraud. Homestead fraud
�3uses higher tax bills for all; therefore, HEA 1344-2009 requires taspa��ers who receive the homestead
s.. dard deduction to ��erify that they are eligible to recei��e the benefit and to pro��ide additioual identifying
information necessary to allow couoty goverument to better monitor homestead filings. This informatiou
will be kept confidential and can only be accessed by authorized county officials. The Department of Local
Go��ernment Fivance �ti�ill use this iuformation to create tools that will help county officials eliminate
homestead fraud.
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Ta�oaver \ame PmMm' Addre s Stah Pxrcd Number Leeal Descriofion:
lan E DIII 715 E Stare 26-12-07-24i-002366-02� NS PT LOT 3 R3
Printtton [N 47670
�omp,ereand.�u,°�o: i�iiou��u�mmm�mmmmmuunmmmu�m�
GIBSON COUYTY AUDITOR, ]Ol N MAIN PRINCETON IY 47670
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Owner 1 First MiECIe �gp
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Madcg AC�ess (reanCei artl s.real �Y. #ate aM LP w0e) �V�artre es PoP�Y aCtress
Sxial Seau¢y AhvnEr (Imt 5 dlglts) Dirvefs License State ID NumDr (last 5 Elgib) swe p(�pr (qpas¢ sp¢��y � P� 4 Debw)
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, �e First /� MitlLle Last
Ma�rg Add�ess (mvneei ana saeel mY. sate aM LP mee) ❑ Same es prapeny aeaess
Sodal Sena¢y Nvnte Qut 5 Eqlb) DriveYS L�ae State ID NunEer (last 5 Nglb) sae p�,�pr (qea� yp�r,yy in Pan 4 Oebv)
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Each undersigned certifies, under penalry of peryury, that the above and foregoing infortnation is true and correGjand 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 unlawfulty, he or
she may be liable for back taxes and substantial financial penalties.
Owm 1 Signa:va _ Dale
Spouse Si�vSae Da;e Teleptme
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GIBSON COUNTY AUDITOR