Homestead_Wilson (16), rt�� � CLAIM FOR HOMESTEAD PROPERTY TAX
- � CREDIT/STANDARD DEDUCTION
'� � State Form 5a73 (RS / 10-01)
���� Presriibed by the DeOartment of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing inslructions.
FORM � YE
H�,o 0 3
��e1 /��^'�'" �`/� certi(y Ihat on the 7st day o( March, 20_
I(VJe) occupied as our principa lace of residence the following descnbed real property for which a Homestead Property T�c Cr ereby daimed:
❑ I(VJe) owned Are buying under wntract
�'-lave a benefidal interest in the entity that is liable for the property taxes on the property and ihat.qyvrt5'th�prc�erty or byyi nder a conVact.
If buying ci, Fee Simple wner �e
r �
Oi
RecoNers ofice wh conV is recorded
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i.QUI(y i _ TOUnShIP
Parcei
County
Legal
Ta�ing tlislrict
Is 6ie �properry in quesUon:
Page
—�Q�� r� ��� I [�freal property ❑ Mobile Homo (I.C. 61.7-7)
i�e residenlial sWCture w Ne land not exceeding ona (1) acre Nat immedialety surtounds Ihal sWGUre is used to produce income, deurihe Ne use and port7on
rryutil��oduceincpm� /
/ ,
GL! �l x�.i� � c'z`"t .
�1 0
County
I hereby ceAi(y ihe a6ove sWfements are W e, conecl and complele.
ar�d sUeat, uty, sfa�. Z/PCOde)
Twvnship
�r .'F^ +'C��.��� : irw .�-r- . . . -2.���• � . . _ � ; . . .. q„ , :,.
� #�*�rASSESSOR�USEONLY�`�� �y`���TRUETAX���-��SSESSEDVALUE +HOMESTEA� �NON�2ESIDENTIAL �["-�
°isy�?t'.k'<�°3:5?�'. ��".m..�--"'�i:i�-�'`�s�� r!°.,v.`IVALUE� r.t�C: �AT.2100%�yOFa.�T.V.�, �..c�7'�VALUEr��`�.�" ����rL�`:4r�'..VALUE+"-.y..�'T;''��
Land not exceeding 1(one) acre immediately ���,�Y.' .i,� s�..����'S� z��3
suvoundingresidentialimprovements. (�� s ��'�i����"� ���<
Other land �`�"'`���`r��.�'�
(Z) tz�� �a-�
- �-�.a�i�v�'_'��_�e'Ti`�'
Tolal land (line 7 plus line 2) . �3�
�3'w3��.�,§�` � ��"��`'� J�
I
Residen6al improvements �e'�'n9 (4) �`¢'����''s�a���sk�'h�.'S
Garage (5) ���� �,�� �� �`��a
� ,i.�."� �"� � '�.�n �'-;'yr
� i._-„� �is
Other improvements (6) �.�%��"�
e
Talal improvements (line 4 through line 6) (7)
Tdal value (line 3 phs line n (g� ,
I hereby certify ihe above is We, coned, and Signature otnssessor oate signea
complete.
Vrrilying action - Signature of Puditar Date signed
�Y"'�°t�sR'�'�s..:+�Nr';c�i�.lii��.-,��.,��v's ��:STANUARD'DEDUCTIONALLOWAtJCE, a'.'�+�ia�u'K�..v��:''.�`.-.F'_�.,i`�.>"'_'_��.'�a�a''�vr#�-^'�
�e' S'x. � . � . c.�: k
20 _ Pay 20 _
Lesser of 12 Homestead
Val ' n or 56,000 S
SignatureafAuditw Dat ' netl
� — � �' �
STATE F02N P369 (Rll8-10) J iR615URFA FOR.N TS-IA
MF20\'ED BY )7AiE BOAitD OF ACCOU�TS, 2009 . PRFSCRIBED BY i}fE DEPARTTIE.\T OF LOC.LL GOVEIL\'��.\T FI\A\CE IC61.1-'__'-B.I
.+d+..,- � , � / 0 , ♦ , 1 � , � � , � �L .�::`, i•vr.:
�
I:_
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
�causes higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who recei��e the homestead
standard deduction to verify that they are eligible to recei��e the benetit and to provide additional identifying
information necessary to allow couoty goverument to better monitor homestead filings. This information
���ill be kept confidential and can only be accessed by authorized county officials. The Department of Local
Go��ernment Finance «�ill use this information to create tools that will help county officials eliminate
Taanamr\am<
Gibson Laneslnc
Complele and return ro:
o,ma, , /
1 �'
Mai � g AtlOrass (rnmCer arW sVOel uty, state
.0� �jv� �.( S
� � /
Pmnem� Address
1560 E BROADWAY ST
PRINCETON IN 47670
homestead fraud.
5[ate Partel \umber
26-I2-OS-Id3-000.946-028
Lspal Dacrintian:
PT N1l' S-LIO 2.935 AC
3a�-78-s os�
�_ -- II�II00]C➢�]�IQV
GBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
Fust
Fvst
MiOtlle
Sama as qoperty aEtlress
MiCdla
Same as prooeny aaCresa
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�� I Drivafa licenselSla:e ID NunOer (laat 5 dIg14) I m I ONer (plaasa speufy in Part < oelaw)
Last
tacn untlersigned certifies, under penalty of perjury, that the atiove and (oregoing information is�tme and correct and that he or she is eligible to receive the
homestead standard deduction on this property. Each undersigned also understands tha;, by claiming additional homestead deductions unlawfully, he or
she may be liable for back tazes and substantial financial penalties.
Owner 1 SigriaNre /� � �
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