Homestead_Gray STATE FORM 53569(Ru t-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVER NMENT FLNASCE IC6-1.1_8.1
IMPORTANT.NOTICE TO'HOMESTE'AD.PROPERTY'OWNERS '' k
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
fuses higher tax bills for all; therefore, HEA 1344-2009 requires taxpayers who receive the homestead 9 s ndard 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.
PARTt"PRomwri iNFORAIATION
Taxpayer Name Property Address State Parcel Number Leal Description:
William J/Susan E Gray 724 E CHRISTIAN ST 26-12-07-304-000.997-028 PT S 7 2 10 .22 AC
PRINCETON IN 47670
Complete and return to: I®'IDl]DEu]f11111ffillOUh®®II LEI IIW1m00�® _
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670 WJ
- PART.2 ,7 A.YP4YER INFORMATION -_ .
Owner 1 First Middle last
lul,t---t—t. A-vvl I oa &RA y
Mailing Address(number and street,city.state and ZIP code) ^mar a as property address
7Z* E et-lRts-rlAPz sC, PRINCZct a j IN x A---7fo'7o
W First Middle Last
S U.S k 0 e LLB t) C.92+6' f
Mailing Address(punter and street,city.state and ZIP code) I same as property address
7Z•4 ' . . eNctsr1 ( # a sc, PRvuc _FTAtJ , 4'7(,Z0
P>RT3: CERTIFIC41'ION.;
Each undersigned certifies,under penally 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 Signature Date
: '
FILED
DEC 27 2012
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GIBSON COUNTY AUDITOR
C1�11(�i FOP, HLl'��STEAD PI1�Pr�TY TAY, C�,�IT FOR'r'"tAP, 19�� ✓
E&:CK FOR FILItJG ir ucrioris p/q-aOR�ir7-oa
i, •..,,,e) • , .'�f' �, ceztify that on the lst da;
�rch, 19_, I, (�'�°) �i°-� � our princioal olace or r 'den� the follvaing descrilr_d r�
oe�rty zor which a t� Pro�sty Tax �edit is her �+ }p.ing clain�3:
I, (ide) � a;�nsi
� are bv�inct urrier �ntract
� haw_ a bnneficial intere ' `he ta�.�ayer
Proe°rty D=scription_ in �� -�� �
Ta�.ina District (City, Ta,�n, Zb�.'nship) : __�
� Tci.,r.s
Farcel [lu-cie�.s or legal d_scripti�n shoe.n on tax statane�t:
�,� S� � /T,�� �� �-a -/G
I- bu.�ina on �ntra�: Cxvners n3n'� (f=__ sirr�le rnm:s) •�°? 9C
- - Con�sact rw.^ord�3 jn P�e�rder's 0=iice - R�card Ii�. Page
I` any o��;_ion of �h_ residen`ial stn�cture or the 1an3, not e��°�ling or.e (1) acre that
ircr.�riiately surrotnds tnat structun_ is us�i �o prociuce incrnw_, descrite the w-e a*ri oor;ien c
;i-ie e�v��ty utilized to produ� inco�
pn��� oti�er �unties in o:hich uxli«dual c��ns or is btr�ing r�.-al prornst}�:
h:s�y c�r`ify ��h� ve s;atgrent is true, mrrect arri cron�lete.
�x .� ,� �. ,� � -�.� � � � C��
C'pllRty '117:.715!�1q
- v +- �- he is :n pay `h_
*Individual °itln_r a��ns or is iuying uner a contract tha� pm:'id �
n�oc�_rty taxes on �h° residence, or has a�.n_iicial interest in th° ta:=oaY°-r•
- FOR ASSESSCH2�S USE Ot;LY -
�}{ -f 7 Y
L��n3 not �v '`. 9 (� °o-�) acre incc�diately
surrow-rling s � � ]�����va�ents
ott�-er � lgg6
Total Lana APR 2
P�sidstial� 3�-rn� � �5
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(6) %o �90
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r=re�y certiiy `�s ai�ave is tn:e, correct,
arx3 cat�c�lete.
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Si^atur_ oL Assssor
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