Homestead_BilderbackCLAIM FOR HOMESTEAD PROPERTY TAX _I YPAR
CREDIT /STANDARD DEDUCTION
State Fenn 5473 M715m=
PmwrbW by the Departirrient of Local Finance JAN 20(!
INSTRUCTIONS: See reverse side for filing instructions.
— —,� 11, '': —'CERTIRCAIMSTATEMENT-
RIM
GIBSON AUU, MR
I (We) certify that m the I at day of March, 20_ '
I (We) occupied as our principal piece of reAdence the following described real property for which a Homestead property Tax Credit is hereby claimed:
0 1 (We) owned ❑ Are buying under contract
aHave a berieficial interest in the entity dud is liable for the property taxes on the property and that owns the property or is buying under a contract
CONTRACT, FIECORDEDa 'Vf'.�'.�C4 Qwl' K
ttbuyirigoricant Fee Shirple mvrmw's naime,
Recim,clees office where contraci is recorded Record number Page
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County
Parcel nwriber
Leo description
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Is the property in "
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O Real Map"
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any portion of the residarifial Wm (1) acre that iminediately offrounds that structure is used to produce incornii, describe the use and portion
ft property dif®d ID PrOdi" incana.
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County
Township
I hereby certify the above stalernerits are true. correct and conipleta.
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( number and shist cry. sfmhq, ZIP code)
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STEAD.-
NON
146� ONLY
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VAWE
VAWE
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valuation or MODO
Signalise of kiditor
Land not exceecting 1 (am) acre immediately
Date signed
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surrounding residential improvements.
Other land
(2)
Total land (Line I jolus Em 2)
(3)
Dwelling
(4)
Residential vrhprovet rents m Annually
Garage
Assessed Mobile /Manu%ctured Horne
Other improvements
(6)
Total ffnpmvernerds (fire. through Eno 6)
(7)
Total value (Ikm 3 phis Ene 7)
(8)
1 hereby certify the above is true, correct and
%Wish" of ftsessar
Date signed
%ftdyuv action - signmLem, Of Amax
Oaft signed
STANDARD DEDU CTl0NAU-0WAN
20_ Pay 2O—
Lesser of 12 Hornestead
valuation or MODO
Signalise of kiditor
Date signed
STATE FORM 53569(R85-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS.2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINANCE IC6-I.1 f 5.1
IMPORTANT NOTICE TO HOMESTEAD PROPERTY OWNERS
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 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.
PARTI: PROPER Y INFORMA !ON
Taxpayer Name Property Address State Parcel Number Leeal Description:
Kenneth James Bilderback 107 S FIFTH ST 26-13-19-202-000.025-005 OLD PLAN 44PT145PT
FRANCISCO IN 47649
Complete and return to: 011111 I lllELl!cJU]l,,GI f(,I IEIf IInll IEIREflgfl3
GIBSON COUNTY AUDITOR, 101 N MAIN PRINCETON IN 47670
-PART 2: TAXPAYER INFORMATION _ ",'.
OMmer 1 First Middle Last
tCEN /JEt M 11 �E�/��c�
Ma rig dress(number and street,city.state and ZIP code) .r��
O. 26 n_Same as property address �7
/ O7 5 LY19 MA c/Sco S -i
spouse First Middle Last
Mailing Address(number and street,city,state and ZIP code) Same as property address
Social Security Number(last 5 digits) Drivers License/State ID Number(last 5 digits) State Other(please specify in Pan 4 below)
4a , MP 0 rei
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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 I Signature Date
< '
;24,9 PART 4:ADDITIONAL INFORMATION,:h
• NOV 14 2012
—
GIBSON COUNTY AUDITOR •