Homestead_DurnilCUlIM FOR FlOAAESTEAD PROPERTYTAX
CREDIT/STANDARD DEDUCTION
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Peeacrbe0 by tl�e DeP� af Lo�l Gorermad Few�
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FOR41 Y�
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I(YVe) certily Mat on Me 1 s! day o( Ma�h, 20_
I(We) aoapied as av pi"v�tipal place oi res' " d r 1 prroperly for which a Hanestead Propaly T�c Credit is hereby daimed:
��(VYe) owned ❑ Are bu�vg und trad
Have a benefidal m0erest m the entity Mat is liade Lor Me propeAy haxes m the proprsty and tl�at owns the properry or is buyvg under a contrac[
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fLewrdats at6ce whera mWad is iecaded Re�d numher Pege
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tl any Pwtion of U�e residerCial �re v tl�e I�d nul
d Ihe popeAy u6f�d to produce vimne.
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m¢eedirg one (/) ave tlal inma3atdy a�mm� tliat �ttiva ia uaed tu G� iwome. dm�+ibe the m and patlon
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(nurter erd atree[ oA: ��. zIP ooee)
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� ASSESSOR USE OMLY � a 1- . i iv .. � ? � �`" �2'�VALUE "` �
�+' h.`n �..{t}it � +`. �� " r VALUE�� . AT tOD% OF TTV s .� VALUE X� . xr �.��;"„.�jt{li.�i��y „L�:.�S �SP.tS'i:on.
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Resdenli2l unpfOVefnCnLS or Mfulally '., �`:...fZG. .,, , E... $j� 9 s.... a a �:..
A�d MOhdC / MtarNta�red FiORIB ^� .Y� -�.t,tii � � Q r Jtw.+ -v:
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Tdal value (1'ure 3 pda Gne n (8)
I hereby oerti(y ihe abwe is true. mrtect and Siar�ae at�r o-are sigied
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1�4ilymg aman' SipneEae o1 AudR� Date s��ed
, .$T�wo/umo�nUi�iiro�/wLOwnMC� :.il .�s,.fS.?.'z . ..c,t> t ��y�i4€�
Zb _ Pay 20 _
Lesser of 12 Homest�d
Valuation w 535.000 S
s��ue ota,cm. � �
SfATE FOAM 53569 (RI/&10) TREASURFR FORA1 T$-IA
APPRO\'ED BY STATE BOARD OF ACCOUN�S, 2009 PRESCRIBED BY'f}� DFPARTfEYf OF LOCAL GOl'ER.\'�ffM FTNANCE IC6�I.I�L'-B.I
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Individuals and married couples are limited to one homestead standard deduction. As the receipt of this
•aeduction becomes more beneficial, there is more incenti��e 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 pro��ide additional identifyiug
information necessary to allow county government to better monitor homestead filings. This informatiou
rvill 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 6elp county offcials eliminate
homestead fraud.
Tuna� er \vme
Mary Dumil
ProcemAddm� 1
527 E STATE ST 26-12-07-204-002.770-028
PRINCETONM47670 SEP 17 2012
C.`J.p\,. " V
Cornplete and return [o: �����Q�m��m�
CIBSON COUNTS�I�B�ITrOR;�101 � MAIN PRINCETON IN 47670
�IV ��1�
%
SorJal Seaairy MmiOx (lazt 5 tligits)
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Mitltlie
� s���a�e�
Swe � Other (G�aase sPerLY in PeM1 4 Eelax)
eacn unaers�gnea cenines, unoer penairy or per�ury, ma[ me aoove ana roregomg inrorma[wn is we ana conea ana ma[ ne or sne is eugioie [o recerve i
homestead standard deduction on this property. Each undersigned also understands that, by claiming additional homestead dedudions untawtully, he or
she max be liable for back taues and substantiat financial penalties.
Ovmet,t �i�a'vae (-'�` � Oate
SEP 17 2012
c.�.
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